OBJECTIVES: Patients with locally advanced or metastatic urothelial cancer (la/mUC) have limited treatment options and a poor prognosis. The JAVELIN Bladder 100 (JB100) trial showed that avelumab + BSC led to significant gains in overall survival (OS) and progression-free survival (PFS) vs BSC alone in patients with la/mUC that did not progress after completion of 1L platinum-containing chemotherapy. We examined if avelumab+BSC is a cost-effective therapy vs BSC alone in Taiwan.

METHODS: A partitioned-survival analysis model was used to estimate the costs and effects of avelumab+BSC vs BSC alone over a 20-year time horizon from Taiwan’s National Health Insurance Administration (NHIA) perspective. Patient-level data on efficacy, safety, utility, and treatment exposure, including subsequent therapies, were analysed from JB100 to provide parameters for the model. For OS, PFS, and time-to-treatment discontinuation, log-normal, Weibull, and exponential distributions were used, respectively. For utilities, a mixed-effects model was generated. A 2-year financial stopping rule was applied to avelumab according to NHIA’s reimbursement guidance for immune checkpoint inhibitors. Costs of healthcare resources, drug acquisition, adverse events, and progression were identified through publicly available data sources and clinician interviews. The model estimated total costs, life-years (LYs), and quality-adjusted life years (QALYs).

RESULTS: In the modeled base case, avelumab+BSC increased survival vs BSC alone by 0.79 LYs (2.93 vs 2.14) and 0.61 QALYs (2.15 vs 1.54). The incremental cost-effectiveness ratio (ICER) for avelumab+BSC vs BSC alone was less than twice the GDP per capita per QALY gained. Seventy-two percent of the probabilistic sensitivity analyses fell within the same cost-effectiveness threshold. Results of scenario analysis indicated that LY and QALY gains were most sensitive to alternative survival extrapolations for both avelumab+BSC and BSC alone.

CONCLUSIONS: This analysis demonstrates the cost-effectiveness of avelumab+BSC vs BSC alone as a 1L maintenance treatment after completion of platinum-containing chemotherapy in patients with la/mUC in Taiwan.