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Background <p>Recent clinical trials (CheckMate 901 and EV-302) have shown that nivolumab plus gemcitabine-cisplatin (N + GC) and enfortumab vedotin plus pembrolizumab (EV + P) significantly improve survival in locally advanced or metastatic urothelial carcinoma (la/mUC). Updated follow-up results from the EV-302 study were presented at the ASCO GU 2025 conference, but the economic feasibility of these therapies remains unclear. This study aims to access the cost-effectiveness of N + GC and EV + P compared to chemotherapy in la/mUC across the US, UK, and China using updated follow-up data from clinical trials.</p> Methods <p>This study employed a Markov model included three health states to evaluate health outcomes and costs. Each model cycle spanned 3 weeks with 2 years, 5 years, 10 years. Patients were divided into two subgroups according to cisplatin eligibility. The outcomes were the costs, Quality Adjusted Life Years (QALYs), and Incremental cost-effectiveness ratios (ICERs).</p> Results <p>For cisplatin-ineligible patients, the 10-year ICERs for EV + P were £136,919/QALY in the UK, $751,897/QALY in the US, and ¥1,158,228/QALY in China. For cisplatin-eligible patients, the 10-year ICERs were £125,441/QALY in the UK, $784,553/QALY in the US, and ¥1,096,445/QALY in China. N + GC demonstrated better cost-effectiveness, with 10-year ICERs of £71,202/QALY in the UK, $183,062/QALY in the US, and ¥259,844/QALY in China. Substantial price reductions were required for both therapies to meet willingness-to-pay thresholds.</p> Conclusions <p>While EV + P offered significant survival benefits for la/mUC patients as the first-line therapy, its current pricing makes it economically unfeasible in most settings. N + GC was more cost-effective for cisplatin-eligible patients. Policymakers should consider innovative pricing strategies to ensure equitable access to treatments.</p>

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Updated cost-effectiveness analysis of first-line novel therapies in locally advanced or metastatic urothelial carcinoma across the UK, US, and China

  • 期刊论文

  • 发表日期：

    2025年10月31日

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  • Jingwen Lin,
  • Wu Fu,
  • Caicong You,
  • Xiaobin Song,
  • Maobai Liu,
  • Hongfu Cai

摘要

Background

Recent clinical trials (CheckMate 901 and EV-302) have shown that nivolumab plus gemcitabine-cisplatin (N + GC) and enfortumab vedotin plus pembrolizumab (EV + P) significantly improve survival in locally advanced or metastatic urothelial carcinoma (la/mUC). Updated follow-up results from the EV-302 study were presented at the ASCO GU 2025 conference, but the economic feasibility of these therapies remains unclear. This study aims to access the cost-effectiveness of N + GC and EV + P compared to chemotherapy in la/mUC across the US, UK, and China using updated follow-up data from clinical trials.

Methods

This study employed a Markov model included three health states to evaluate health outcomes and costs. Each model cycle spanned 3 weeks with 2 years, 5 years, 10 years. Patients were divided into two subgroups according to cisplatin eligibility. The outcomes were the costs, Quality Adjusted Life Years (QALYs), and Incremental cost-effectiveness ratios (ICERs).

Results

For cisplatin-ineligible patients, the 10-year ICERs for EV + P were £136,919/QALY in the UK, $751,897/QALY in the US, and ¥1,158,228/QALY in China. For cisplatin-eligible patients, the 10-year ICERs were £125,441/QALY in the UK, $784,553/QALY in the US, and ¥1,096,445/QALY in China. N + GC demonstrated better cost-effectiveness, with 10-year ICERs of £71,202/QALY in the UK, $183,062/QALY in the US, and ¥259,844/QALY in China. Substantial price reductions were required for both therapies to meet willingness-to-pay thresholds.

Conclusions

While EV + P offered significant survival benefits for la/mUC patients as the first-line therapy, its current pricing makes it economically unfeasible in most settings. N + GC was more cost-effective for cisplatin-eligible patients. Policymakers should consider innovative pricing strategies to ensure equitable access to treatments.