Evaluating cost-effectiveness in the evolving treatment landscape for metastatic urothelial carcinoma.

• DOI: 10.1200/jco.2025.43.5_suppl.695
• Publication Date: 2025-02-18T14:42:46Z
• Authors: Constantin Rieger; David A. Pfister; Joerg Schluechter...; Axel Heidenreich; Richard Weiten; Enno Storz
• Keywords: Metastatic Urothelial Carcinoma; Urothelial cancer

695 Background: Metastatic urothelial carcinoma (mUCa) is the most expensive cancer to treat on a per-patient basis, largely due need for frequent interventions and costly follow-up care. In examining first-line therapies, combinations such as enfortumab-vedotin plus pembrolizumab (EV + P) gemcitabine/cisplatin nivolumab show substantial overall survival advantages over standard treatment (SoC) of gemcitabine/cisplatin. This study presents cost-effectiveness analysis mUCa. Methods: We developed Markov model from payer's perspective, utilizing clinical data derived Phase III Checkmate-901 EV302/Keynote-A39 trials. To identify optimal socioeconomic standpoint, we employed Monte Carlo simulation, focusing Germany United States (US). Subsequently, compared incremental ratio (ICER) each modality across various willingness-to-pay (WTP) thresholds. Results: At lifetime horizon, SoC, EV P were associated with average costs €163,424 (US: $458,006), €206,853 $597,802), €401,170 $1,228,455), respectively, while achieving QALYs 1.21, 1.71, 2.31, respectively. The ICERs newer strategies €87,340 $281,142) €216,140 $700,448) P. commonly accepted WTP threshold €/$100,000, emerged strategy in Germany, would necessitate price reduction 46% 82%) achieve cost-effectiveness. Conclusions: nearly double combination current SoC; however, may not be justifiable strict perspective. Despite offering lower oncological benefits, should considered therapy its favorable cost-effectiveness, particularly Europe. Furthermore, identifying individual risk factors crucial optimizing therapeutic responses managing future.