ArticleBMJ open2025
Cost-effectiveness analysis of enfortumab vedotin and pembrolizumab versus chemotherapy for patients with untreated advanced urothelial cancer in the United Kingdom.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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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.
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Who cites it
3 citing papers in PubMed.
- Quality of life with EV-302 in advanced urothelial carcinoma: lessons and implications.Translational cancer research · 2026Article
- Oncologic outcome and safety profile of first-line enfortumab vedotin plus pembrolizumab vs. conventional chemotherapy in advanced urothelial cancer.Exploration of targeted anti-tumor therapy · 2026Article
- Cost-effectiveness of disitamab vedotin plus toripalimab in HER2-expressing advanced urothelial carcinoma in China.Frontiers in pharmacology · 2026Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesEnfortumab vedotin and pembrolizumab (EV-Pem) have recently been shown to improve the prognosis of patients with untreated locally advanced or metastatic urothelial carcinoma (la/mUC) in a randomised phase three clinical trial. This study aims to evaluate the cost-effectiveness of EV-Pem as a first-line treatment for patients with la/mUC.
designWe developed a three-state Markov model to simulate the treatment pathways for patients with la/mUC. Costs associated with drugs, treatment monitoring, adverse event management and utility inputs were obtained from national cost databases, trial data and existing literature. In addition to the base-case analysis, sensitivity, threshold and subgroup analyses were performed to assess uncertainty.
settingThe National Health Service and Personal Social Services perspective.
participantsA hypothetical English cohort of patients with la/mUC.
interventionsFirst-line treatment with either EV-Pem or chemotherapy.
main outcome measuresCosts, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon as primary outcomes.
resultsIn patients with la/mUC, EV-Pem increased health outcomes by 0.82 QALYs (95% uncertainty interval (UI) 0.66 to 0.92) at an incremental cost of £76 793.75 (95% UI 75 759.96 to 77 750.72) versus chemotherapy, yielding an ICER of £93 650.92 per QALY (95% UI £83 471.84 to 116 739.74). One-way sensitivity analysis revealed that factors such as utility values, EV prices and discount rates influence model outcomes, but these variations did not alter the conclusion. Probabilistic sensitivity analysis indicated that, at a willingness-to-pay threshold of £30 000 per QALY, the probability of cost-effectiveness is 0. Results remained robust across subgroup analyses.
conclusionIn this economic model analysis, EV-Pem is not cost-effective compared with first-line chemotherapy in the UK, and a price reduction may be necessary.
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