Evidence map›Paper›PMID 40220863›Full record

ArticleValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research2025

Cost-Effectiveness of Enfortumab Vedotin and Pembrolizumab for First-Line Metastatic Urothelial Cancer in the United States.

Tanvi V Chiddarwar, Hawre Jalal, Fernando Alarid-Escudero, David Garibay, Praveen Kumar, Krishna Roy Chowdhury, Bruce L Jacobs, Paul Mathew, John B Wong, Karen M Kuntz

Abstract read
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In one paragraph

Article in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Tanvi V ChiddarwarDivision of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: chidd002@umn.edu.
Hawre JalalSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
Fernando Alarid-EscuderoDepartment of Health Policy, School of Medicine, Stanford University, Stanford, CA.
David GaribaySchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
Praveen KumarDepartment of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Krishna Roy ChowdhurySchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
Bruce L JacobsDivision of Health Services Research, Department of Urology, University of Pittsburgh, Pittsburgh, PA.
Paul MathewSchool of Medicine, Tufts University, Boston, MA.
John B WongSchool of Medicine, Tufts University, Boston, MA.
Karen M KuntzDivision of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN.

Funding

Population Modeling of Bladder Cancer Detection and ControlU01CA265750 · NCI · BROWN UNIVERSITY · PI JALAL, HAWRE, TRIKALINOS, THOMAS · 2021 to 2025
$3.4M
NCI NIH HHS U01 CA265750
6 · The paper itself

Abstract

objectivesThe EV-302 trial demonstrated that the combination of enfortumab vedotin and pembrolizumab (EV+P) significantly improved progression-free and overall survival in patients with metastatic urothelial cancer. However, the economic value of this regimen remains uncertain. Our study aims to evaluate the cost-effectiveness of EV+P versus platinum-based chemotherapy as first-line treatment for metastatic urothelial cancer from the US payer perspective.

methodsWe developed a cohort state-transition model to simulate the lifetime costs and effectiveness of a cohort of 69-year-olds with metastatic urothelial cancer, resembling those in the EV-302 trial. Costs and utilities were derived from published literature to calculate the quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio for EV+P relative to chemotherapy. We conducted deterministic and probabilistic sensitivity analyses to identify factors influencing the cost-effectiveness.

resultsIn the base case, the chemotherapy strategy costs $80 874, yielding 1.26 QALYs and 1.69 life years. The EV+P strategy costs $752 637, yielding 2.54 QALYs and 3.31 life years. This resulted in an incremental cost-effectiveness ratio of $525 239/QALY and $414 927/life year. To achieve cost-effectiveness at a $150 000/QALY threshold, the price of the combination therapy would need to be reduced by 76%. A probabilistic sensitivity analysis indicated that EV+P was cost-effective in 0% of the simulations.

conclusionsAlthough EV+P therapy is effective, it is not cost-effective at its current price as a first-line therapy in the United States at a cost-effectiveness threshold of $150 000/QALY. A substantial reduction in its drug cost is required to be cost-effective at commonly accepted willingness-to-pay thresholds.

Indexed as

Antibodies, MonoclonalAntibodies, Monoclonal, HumanizedAntineoplastic Combined Chemotherapy ProtocolsUrinary Bladder NeoplasmsUrologic NeoplasmsAgedAntineoplastic Agents, ImmunologicalCost-Benefit AnalysisFemaleHumansMaleQuality-Adjusted Life YearsUnited StatesAntibodies, MonoclonalAntibodies, Monoclonal, HumanizedAntineoplastic Agents, Immunologicalenfortumab vedotinpembrolizumabcohort-state transition modelcost-effectivenessimmunotherapytargeted therapyurothelial cancer

Identifiers

PMID40220863
PMCPMC12227290

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.