West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Public Health. 2022 Apr 27;10:837854. doi: 10.3389/fpubh.2022.837854. eCollection 2022.
Avelumab (MSB0010718C) is a fully human anti-programmed cell death ligand 1(PD-L1) antibody against PD-L1 interactions and enhances immune activation against tumor cells in the meantime. Avelumab has been approved for locally advanced or metastatic urothelial cancer (mUC) after disease progression in several countries. We therefore conducted this study to evaluate the cost-effectiveness of avelumab maintenance therapy for advanced or mUC from the perspective of the United States (US) and China payer.
A Markov simulation model was performed based on clinical trial JAVELIN Bladder 100. Utilities and costs adopted in this analysis were derived from published literature and clinical trials. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the avelumab maintenance therapy group (AVE group) and the best supportive care group (CON group).
The ICER of the AVE group compared with the CON group were $38,369.50 and $16,150.29 per QALYs in the overall population and in the PD-L1-positive population, respectively. While the ICER of AVE group compared with CON group were $241,610.25 and $100,528.29 per QALYs in the overall population and in the PD-L1-positive population, respectively.
Avelumab maintenance therapy was a cost-effective first-line treatment compared with BSC in patients with mUC which were not progressed with platinum-based chemotherapy not only in the PD-L1-positive population but also in the overall population based on the current willingness to pay (WTP) of $150,000 in the US. It was not cost-effective both in the overall population and in the PD-L1 positive population at the WTP threshold of $30,447.09 in China.
avelumab（MSB0010718C）是一种针对 PD-L1 相互作用的完全人源抗程序性细胞死亡配体 1（PD-L1）抗体，同时增强了针对肿瘤细胞的免疫激活。avelumab 已在几个国家获得批准，用于疾病进展后的局部晚期或转移性尿路上皮癌（mUC）。因此，我们进行了这项研究，从美国（US）和中国支付者的角度评估 avelumab 维持治疗晚期或 mUC 的成本效益。
基于 JAVELIN Bladder 100 临床试验，进行了 Markov 模拟模型。本分析中采用的效用和成本来自已发表的文献和临床试验。计算增量成本效益比（ICER），以比较 avelumab 维持治疗组（AVE 组）和最佳支持治疗组（CON 组）。
AVE 组与 CON 组的 ICER 分别为总体人群和 PD-L1 阳性人群每 QALY 的 38369.50 美元和 16150.29 美元。AVE 组与 CON 组的 ICER 分别为总体人群和 PD-L1 阳性人群每 QALY 的 241610.25 美元和 100528.29 美元。
对于未接受含铂化疗进展的 mUC 患者，avelumab 维持治疗与 BSC 相比，不仅在 PD-L1 阳性人群中，而且在总体人群中，均具有成本效益，基于当前美国 150000 美元的意愿支付（WTP）阈值。在 WTP 阈值为 30447.09 美元时，在中国的总体人群和 PD-L1 阳性人群中均不具有成本效益。
