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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1412292

Enfortumab vedotin plus pembrolizumab as a first-line treatment for advanced urothelial carcinoma: A cost-effectiveness analysis from China based on the EV-302 trial

Provisionally accepted
Maojin You Maojin You Qiaoyan Zheng Qiaoyan Zheng *Ying He Ying He *
  • Mindong Hospital, Fujian Medical University, Ningde, China

The final, formatted version of the article will be published soon.

    Background: The efficacy and safety of enfortumab vedotin combined with pembrolizumab (EV-PEMB) was investigated as a first-line treatment for advanced urothelial carcinoma (UC) in a phase III clinical trial (EV-302). The trial findings indicated significant prolonged progression-free survival (PFS) and overall survival (OS) compared to chemotherapy with a favorable safety profile. However, EV-PEMB is costly and it is unknown whether it is cost-effective compared to chemotherapy.This study aims to perform a cost-effectiveness analysis of EV-PEMB versus chemotherapy as a first-line treatment for advanced UC from the perspective of the Chinese healthcare system. It seeks to clarify the economic and clinical value of EV-PEMB, facilitating more informed and rational treatment decisions. Methods: A Markov model with three distinct health states was developed to assess the cost-effectiveness of EV-PEMB as a first-line treatment for advanced UC versus chemotherapy based on the EV-302 trial. Drug costs were obtained from national tender prices. Other expenses and utility values were sourced from the literature or expert advice. The findings of the study included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). We conducted a one-way sensitivity analysis and probabilistic sensitivity analysis to ensure the model’s robustness. Results: The EV-PEMB regimen demonstrated a gain of 3.22 QALYs at $375,420.24, compared to the chemotherapy regimen with 1.70 QALYs at $23,369.67. ICER for EV-PEMB compared to chemotherapy was at $232,256.16 per QALY gained. In China, at a willingness-to-pay threshold of $38,133 per QALY, EV-PEMB has a 0% probability of being cost-effective as a first-line treatment for advanced UC compared to chemotherapy. Conclusion: From the perspective of the Chinese healthcare system, EV-PEMB is unlikely to be a cost-effective first-line treatment option for advanced UC compared to chemotherapy. To achieve cost-effectiveness, significant reductions in the prices of enfortumab vedotin and pembrolizumab are required. These results may influence healthcare providers' and patients' attitudes towards treatment choices.

    Keywords: Cost-Effectiveness, Enfortumab vedotin, Pembrolizumab, urothelial carcinoma, First-line treatment

    Received: 04 Apr 2024; Accepted: 05 Sep 2024.

    Copyright: © 2024 You, Zheng and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Qiaoyan Zheng, Mindong Hospital, Fujian Medical University, Ningde, China
    Ying He, Mindong Hospital, Fujian Medical University, Ningde, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.