1
|
Porte F, Granghaud A, Chang J, Kearney M, Morel A, Plessala I, Cawston H, Roiz J, Xiao Y, Solbes MN, Lambert P, Ravaud A, Loriot Y, Thiery-Vuillemin A, Lévy P. Cost-effectiveness of avelumab first-line maintenance therapy for adult patients with locally advanced or metastatic urothelial carcinoma in France. PLoS One 2024; 19:e0302548. [PMID: 38728337 PMCID: PMC11086848 DOI: 10.1371/journal.pone.0302548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND This study evaluated the cost-effectiveness of avelumab first-line (1L) maintenance therapy plus best supportive care (BSC) versus BSC alone for adults with locally advanced or metastatic urothelial carcinoma (la/mUC) that had not progressed following platinum-based chemotherapy in France. METHODS A three-state partitioned survival model was developed to assess the lifetime costs and effects of avelumab plus BSC versus BSC alone. Data from the phase 3 JAVELIN Bladder 100 trial (NCT02603432) were used to inform estimates of clinical and utility values considering a 10-year time horizon and a weekly cycle length. Cost data were estimated from a collective perspective and included treatment acquisition, administration, follow-up, adverse event-related hospitalization, transport, post-progression, and end-of-life costs. Health outcomes were measured in quality-adjusted life-years (QALYs) and life-years gained. Costs and clinical outcomes were discounted at 2.5% per annum. Incremental cost-effectiveness ratios (ICERs) were used to compare cost-effectiveness and willingness to pay in France. Uncertainty was assessed using a range of sensitivity analyses. RESULTS Avelumab plus BSC was associated with a gain of 2.49 QALYs and total discounted costs of €136,917; BSC alone was associated with 1.82 QALYs and €39,751. Although avelumab plus BSC was associated with increased acquisition costs compared with BSC alone, offsets of -€20,424 and -€351 were observed for post-progression and end-of-life costs, respectively. The base case analysis ICER was €145,626/QALY. Sensitivity analyses were consistent with the reference case and showed that efficacy parameters (overall survival, time to treatment discontinuation), post-progression time on immunotherapy, and post-progression costs had the largest impact on the ICER. CONCLUSIONS This analysis demonstrated that avelumab plus BSC is associated with a favorable cost-effectiveness profile for patients with la/mUC who are eligible for 1L maintenance therapy in France.
Collapse
Affiliation(s)
- Fanny Porte
- Health Economics Department, Merck Santé S.A.S., Lyon, France
| | - Anna Granghaud
- Health Economics department, Pfizer S.A.S., Paris, France
| | - Jane Chang
- Health Economics department, Pfizer, New York, NY, United States of America
| | - Mairead Kearney
- Global Value Demonstration, Market Access and Pricing, The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Aya Morel
- Health Economics department, Pfizer S.A.S., Paris, France
| | - Ingrid Plessala
- Health Economics & Market Access (HEMA), Amaris Consulting, Paris, France
| | - Hélène Cawston
- Health Economics & Market Access (HEMA), Amaris Consulting, Paris, France
| | - Julie Roiz
- Health Economics, Evidera, London, United Kingdom
| | - Ying Xiao
- Health Economics, Evidera, London, United Kingdom
| | | | | | - Alain Ravaud
- Department of Medical Oncology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Yohann Loriot
- Department of Medical Oncology, Institute Gustave-Roussy, Villejuif, France
| | - Antoine Thiery-Vuillemin
- Department of Medical Oncology, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Pierre Lévy
- Université Paris-Dauphine, Université-PSL, [LEDA], LEGOS, Paris, France
| |
Collapse
|
2
|
Critchlow S, Bullement A, Crabb S, Jones R, Christoforou K, Amin A, Xiao Y, Kapetanakis V, Benedict Á, Chang J, Kearney M, Eccleston A. Cost-effectiveness analysis for avelumab first-line maintenance treatment of advanced urothelial carcinoma in Scotland. Future Oncol 2024; 20:459-470. [PMID: 37529943 DOI: 10.2217/fon-2023-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Aim: The cost-effectiveness of avelumab first-line maintenance treatment for locally advanced or metastatic urothelial carcinoma in Scotland was assessed. Materials & methods: A partitioned survival model was developed comparing avelumab plus best supportive care (BSC) versus BSC alone, incorporating JAVELIN Bladder 100 trial data, costs from national databases and published literature and clinical expert validation of assumptions. Incremental cost-effectiveness ratio (ICER) was estimated using lifetime costs and quality-adjusted life-years (QALY). Results: Avelumab plus BSC had incremental costs of £9446 and a QALY gain of 0.63, leading to a base-case (deterministic) ICER of £15,046 per QALY gained, supported by robust sensitivity analyses. Conclusion: Avelumab first-line maintenance is likely to be a cost-effective treatment for locally advanced or metastatic urothelial carcinoma in Scotland.
Collapse
Affiliation(s)
| | | | - Simon Crabb
- University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Robert Jones
- University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | | | - Amerah Amin
- Merck Serono Ltd. 5 New Square, Feltham, TW14 8HA, UK, an affiliate of Merck KGaA
| | - Ying Xiao
- Evidera, 201 Talgarth Road, London, W6 8BJ, UK
| | | | | | - Jane Chang
- Pfizer, 235 E 42nd Street, New York, NY 10017, USA
| | - Mairead Kearney
- Merck Healthcare KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany
| | | |
Collapse
|
3
|
Mucherino S, Lorenzoni V, Triulzi I, Del Re M, Orlando V, Capuano A, Danesi R, Turchetti G, Menditto E. Cost-Effectiveness of Treatment Optimisation with Biomarkers for Immunotherapy in Solid Tumours: A Systematic Review. Cancers (Basel) 2024; 16:995. [PMID: 38473355 DOI: 10.3390/cancers16050995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
This study investigated the health economic evaluations of predictive biomarker testing in solid tumours treated with immune checkpoint inhibitors (ICIs). Searching PubMed, EMBASE, and Web of Science from June 2010 to February 2022, 58 relevant articles were reviewed out of the 730 screened. The focus was predominantly on non-small cell lung cancer (NSCLC) (65%) and other solid tumours (40%). Among the NSCLC studies, 21 out of 35 demonstrated cost-effectiveness, notably for pembrolizumab as first-line treatment when preceded by PD-L1 assessment, cost-effective at a threshold of $100,000/QALY compared to the standard of care. However, for bladder, cervical, and triple-negative breast cancers (TNBCs), no economic evaluations met the affordability threshold of $100,000/QALY. Overall, the review highlights a certain degree of uncertainty about the cost-effectiveness of ICI. In particular, we found PD-L1 expression associated with ICI treatment to be a cost-effective strategy, particularly in NSCLC, urothelial, and renal cell carcinoma. The findings suggest the potential value of predictive biomarker testing, specifically with pembrolizumab in NSCLC, while indicating challenges in achieving cost-effectiveness for certain other solid tumours.
Collapse
Affiliation(s)
- Sara Mucherino
- CIRFF-Centre of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, via D Montesano 49, 80131 Naples, Italy
| | | | - Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Valentina Orlando
- CIRFF-Centre of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, via D Montesano 49, 80131 Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology 'L. Donatelli', Department of Experimental Medicine, University of Campania 'L. Vanvitelli', Via Costantinopoli 16, 80138 Naples, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Enrica Menditto
- CIRFF-Centre of Pharmacoeconomics and Drug Utilization Research, Department of Pharmacy, University of Naples Federico II, via D Montesano 49, 80131 Naples, Italy
| |
Collapse
|
4
|
Joyce DD, Sharma V, Williams SB. Cost-Effectiveness and Economic Impact of Bladder Cancer Management: An Updated Review of the Literature. PHARMACOECONOMICS 2023; 41:751-769. [PMID: 37088844 DOI: 10.1007/s40273-023-01273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/03/2023]
Abstract
Bladder cancer remains one of the costliest malignancies to manage. We provide a narrative review of literature assessing the economic burden and cost-effectiveness of bladder cancer treatment and surveillance. This is an update to a previous review and focuses on data published within the past 10 years. We queried PubMed and MEDLINE for all bladder cancer cost-related literature between 2013 and 2023. After initial screening, 117 abstracts were identified, 50 of which were selected for inclusion in our review. Management of disease recurrence and treatment complications contributes significantly to the high cost of care. High-value interventions are therefore treatments that improve recurrence-free and overall survival at minimal additional toxicity. De-escalation of surveillance and diagnostic interventions may help to reduce costs in this space without compromising oncologic control. The persistently rising cost of novel cancer drugs undermines their value when only modest gains in efficacy are observed. Multiple cost-effectiveness analyses have been published and are useful for contextualizing the cost, efficacy, and impact on quality of life that interventions have in this population. Further cost-effectiveness work is needed to better characterize the impact that treatment costs have on patients' financial well-being and quality of life.
Collapse
Affiliation(s)
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Stephen B Williams
- Division of Urology, High Value Care, UTMB Health System, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0540, USA.
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
5
|
Xie Q, Zheng H, Chen Y, Peng X. Cost-Effectiveness of Avelumab Maintenance Therapy Plus Best Supportive Care vs. Best Supportive Care Alone for Advanced or Metastatic Urothelial Carcinoma. Front Public Health 2022; 10:837854. [PMID: 35570929 PMCID: PMC9093135 DOI: 10.3389/fpubh.2022.837854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
Objective Avelumab (MSB0010718C) is a fully human anti-programmed cell death ligand 1(PD-L1) antibody against PD-L1 interactions and enhances immune activation against tumor cells in the meantime. Avelumab has been approved for locally advanced or metastatic urothelial cancer (mUC) after disease progression in several countries. We therefore conducted this study to evaluate the cost-effectiveness of avelumab maintenance therapy for advanced or mUC from the perspective of the United States (US) and China payer. Methods A Markov simulation model was performed based on clinical trial JAVELIN Bladder 100. Utilities and costs adopted in this analysis were derived from published literature and clinical trials. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the avelumab maintenance therapy group (AVE group) and the best supportive care group (CON group). Results The ICER of the AVE group compared with the CON group were $38,369.50 and $16,150.29 per QALYs in the overall population and in the PD-L1–positive population, respectively. While the ICER of AVE group compared with CON group were $241,610.25 and $100,528.29 per QALYs in the overall population and in the PD-L1–positive population, respectively. Conclusion Avelumab maintenance therapy was a cost-effective first-line treatment compared with BSC in patients with mUC which were not progressed with platinum-based chemotherapy not only in the PD-L1–positive population but also in the overall population based on the current willingness to pay (WTP) of $150,000 in the US. It was not cost-effective both in the overall population and in the PD-L1 positive population at the WTP threshold of $30,447.09 in China.
Collapse
Affiliation(s)
- Qian Xie
- West China Hospital, Sichuan University, Chengdu, China
| | - Hanrui Zheng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Chen
- West China Hospital, Sichuan University, Chengdu, China
| | - Xingchen Peng
- West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|