Journal article
Cost-Effectiveness Analysis of Pembrolizumab for Bacillus Calmette-Guerin-Unresponsive Carcinoma In Situ of the Bladder
The Journal of urology, Vol.205(5), pp.1326-1334
05/01/2021
DOI: 10.1097/JU.0000000000001515
PMID: 33347775
Abstract
Purpose: Patients with bacillus Calmette-Guerin-unresponsive carcinoma in situ are treated with radical cystectomy or salvage intravesical chemotherapy. Recently, pembrolizumab was approved for bacillus CalmetteGuerin-unresponsive carcinoma in situ.
Materials and Methods: We used a decision-analytic Markov model to compare pembrolizumab, salvage intravesical chemotherapy (with gemcitabine-docetaxel induction+monthly maintenance) and radical cystectomy for patients with bacillus Calmette-Guerin-unresponsive carcinoma in situ who are radical cystectomy candidates (index patient 1) or are unwilling/unable to undergo radical cystectomy (index patient 2). The model used a U.S. Medicare perspective with a 5-year time horizon. One-way and probabilistic sensitivity analyses were performed. Incremental cost-effectiveness ratios were compared using a willingness to pay threshold of $100,000/quality-adjusted life year.
Results: For index patient 1, pembrolizumab was not cost-effective relative to radical cystectomy (incremental cost-effectiveness ratios $1,403,008/quality-adjusted life year) or salvage intravesical chemotherapy (incremental cost-effectiveness ratios $2,011,923/quality-adjusted life year). One-way sensitivity analysis revealed that pembrolizumab only became cost-effective relative to radical cystectomy with a >93% price reduction. Relative to radical cystectomy, salvage intravesical chemotherapy was cost-effective for time horizons <5 years and nearly cost-effective at 5 years (incremental cost-effectiveness ratios $118,324/quality-adjusted life year). One-way sensitivity analysis revealed that salvage intravesical chemotherapy became cost-effective relative to radical cystectomy if risk of recurrence or metastasis at 2 years was less than 55% or 5.9%, respectively. For index patient 2, pembrolizumab required >90% price reduction to be cost-effective (incremental cost-effectiveness ratios $1,073,240/quality-adjusted life year). Pembrolizumab was cost-effective in 0% of 100,000 microsimulations in probabilistic sensitivity analyses for both index patients.
Conclusions: At its current price, pembrolizumab is not cost-effective for bacillus Calmette-Guerin-unresponsive carcinoma in situ relative to radical cystectomy or salvage intravesical chemotherapy. Although gemcitabine-docetaxel is not cost-effective relative to radical cystectomy at 5 years, further studies may validate its cost-effectiveness if recurrence and metastasis thresholds are met.
Details
- Title: Subtitle
- Cost-Effectiveness Analysis of Pembrolizumab for Bacillus Calmette-Guerin-Unresponsive Carcinoma In Situ of the Bladder
- Creators
- Kevin M. Wymer - Department of Urology, Mayo Clinic , Rochester, Minnesota.Vidit Sharma - Mayo ClinicChristopher S. Saigal - University of California, Los AngelesKarim Chamie - University of California, Los AngelesMark S. Litwin - University of California, Los AngelesVignesh T. Packiam - Mayo ClinicMatthew Mossanen - Brigham and Women's HospitalLance C. Pagliaro - Mayo ClinicBijan J. Borah - Department of Health Services Research, Mayo Clinic, Rochester, MinnesotaStephen A. Boorjian - Mayo Clinic in Arizona
- Resource Type
- Journal article
- Publication Details
- The Journal of urology, Vol.205(5), pp.1326-1334
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/JU.0000000000001515
- PMID
- 33347775
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Number of pages
- 9
- Grant note
- Veterans Affairs' Health Services Research and Development Fellowship
- Language
- English
- Date published
- 05/01/2021
- Academic Unit
- Urology
- Record Identifier
- 9984319988602771
Metrics
10 Record Views