Table 2.
CEAs in advanced UC.
| Treatment | Reference | Cohort | Method | Total Cost | QALY | ICER (Per QALY) | WTP Threshold (Per QALY) | Conclusion |
|---|---|---|---|---|---|---|---|---|
| First-line | Hale et al., 2020 [15], USA | First-line PB vs. gemcitabine plus carboplatin (GCa) in cisplatin-ineligible patients with CPS ≥ 10 | Partitioned survival model, 20-year time horizon, third-party payor perspective, AEs included, base year 2018 | PB: $225,334 GCa: $66,773 |
PB: 2.91 GCa: 0.90 |
PB/GCa: $78,925 | $150,000 | PB may be cost-effective relative to GCa for 1L treatment for PD-L1 positive, cisplatin-ineligible patients with metastatic UC |
| Second-line | Parmar et al., 2020 [16], Canada | AZ vs. chemotherapy (taxanes) as second line treatment after progression on cisplatin | Partitioned survival model, 5-year horizon, Canadian healthcare system perspective, includes AEs and end-of-life care, base year 2018 |
AZ: C$90,290 Chemo: C $8,466 |
AZ: 0.75 Chemo: 0.76 |
AZ/Chemo: C $430,652 AZ/Chemo: C$334,387 (for subgroup PDL1 expression > 5%) AZ/Chemo: C $305,408 (for extended 10-year horizon) |
C$100,000 | AZ is not considered cost-effective relative to taxanes as 2L treatment for advanced UC ICER improves with PD-L1 stratification and longer time horizon |
| Slater et al., 2020 [17], USA | PB vs. chemotherapy (taxanes) after progression on first-line therapy Secondary analysis comparing PB and AZ |
Partitioned survival model, 20-year horizon, third-party payor perspective, base year 2018 | PB: $140,556 Chemo: $34,257 PB: $152,753 AZ: $179,211 |
PB: 1.79 Chemo: 0.66 PB: 1.79 AZ: 1.03 |
PB/Chemo: $93,481 PB/AZ: Dominates (−$34,813) |
$100,000 | PB may be cost-effective compared to taxanes for advanced UC Indirect comparison suggests PB more cost-effective than AZ |
|
| Criss et al., 2018 [18], USA | Cost-effectiveness of PD-L1 testing in second-line treatment. Compared chemotherapy (taxanes), PB, and PB for PD-L1 > 1% with chemotherapy for PD-L1 < 1% | Microsimulation model, 5-year horizon, US healthcare system perspective, base year 2017 | PD-L1 > 1%: $27,579 Chemo: $17,732 PB: $40,573 |
PD-L1 > 1%: 0.51 Chemo: 0.43 PB: 0.58 |
PD-L1 > 1%/chemo: $122,933 PB/PD-L1 >1%: $197,383 |
$100,000 | The cost-effectiveness of PB improves when PD-L1 status is included, but still fails to meet the WTP threshold | |
| Sarfaty et al., 2018 [19], multi-national * | PB vs. chemotherapy (taxanes) for second-line treatment | Markov model, 5-year horizon, third-party payor perspective, included AEs, base year 2017 | * USA: $44,325 UK: $33,271 Canada: $33,869 Australia: $36,154 |
* USA: 0.36 UK: 0.36 Canada: 0.37 Australia: 0.36 |
USA: $122,557 UK: $91,995 Canada: $90,099 Australia: $99,966 |
USA: $150,000 UK: $65,000 Canada: $80,000 Australia: $60,000 |
PB may be cost-effective compared to chemotherapy at the WTP threshold set for the USA | |
| Srivastava et al., 2018 [20], Sweden | PB vs. chemotherapy (taxanes, vinflunine) for second-line treatment | Partitioned survival model, 15-year horizon, included AEs, base year 2018 | PB: €98,354 Vinflunine: €28,501 PB: €98,348 Taxane: €25,182 PB: €98,208 Chemo: €25,054 |
PB: 1.99 Vinflunine: 0.61 PB: 1.99 Taxane: 1.09 PB:1.99 Chemo: 0.97 |
PB/Vinflunine: €50,529 PB/Taxane: €81,356 PB/Chemo: €71,924 |
€100,000 | PB may be cost-effective relative to vinflunine and taxanes |
* Sarfaty et al. only reported incremental costs and QALY for each country, not the total. Additionally, the primary authors converted each currency to US dollars.