OBJECTIVES: Avelumab is a fully human IgG1 antibody that targets PD-L1. Avelumab is approved in Finland as monotherapy for first-line maintenance treatment of adult patients with locally advanced or metastatic urothelial carcinoma that has not progressed during platinum-based chemotherapy. This study aimed to assess the cost-effectiveness of avelumab + best supportive care (BSC) versus BSC alone in the aforementioned indication in the Finnish healthcare setting.

METHODS: Using a Finnish healthcare perspective, a cost-utility analysis was conducted by building a 3-state partitioned survival model, which was used to estimate costs, effects, and an incremental cost-effectiveness ratio (ICER) during a base case time horizon of 25 years. Efficacy, safety, and utility parameters were derived from the phase 3 study JAVELIN Bladder 100, which was the primary data source, together with Finnish expert input and cost literature. Clinical study results were extrapolated with parametric survival curves, including spline-based models for progression-free survival. Both costs (2020 euros) and effects were discounted at a 3% annual discount rate. In addition, scenario analyses and a probabilistic sensitivity analysis were conducted to assess the effect and magnitude of uncertainty.

RESULTS: In the base case analysis, avelumab + BSC achieved 1.00 additional life-year (3.94 vs 2.95) and 0.63 (2.44 vs 1.82) quality-adjusted life-years (QALYs) compared with BSC alone. The ICER was <3 times the GDP per capita per QALY gained. Sensitivity analyses show that the relative dose intensity of avelumab, along with parameters relating to subsequent treatment lines, have a significant impact on cost-effectiveness.

CONCLUSIONS: Avelumab provides a significant clinical improvement in a patient population affected by a severe form of cancer that usually carries a relatively poor prognosis. In addition, avelumab is a potentially cost-effective treatment option compared to BSC alone, in patients eligible for first-line maintenance treatment of locally advanced or metastatic urothelial cancer in the Finnish healthcare setting.