Cost-effectiveness of perioperative durvalumab plus neoadjuvant chemotherapy for muscle invasive bladder cancer in the United States.

BACKGROUND

The management of muscle-invasive bladder cancer (MIBC) remains challenging. The phase III NIAGARA trial showed that adding durvalumab to neoadjuvant chemotherapy significantly enhances event-free and overall survival for MIBC patients. However, due to the high cost of durvalumab, assessing its cost-effectiveness is crucial.

OBJECTIVE

To compare the cost-effectiveness of durvalumab with neoadjuvant chemotherapy versus neoadjuvant chemotherapy alone in operable MIBC, from the perspective of U.S. healthcare payers.

DESIGN

A model-based pharmacoeconomic evaluation.

METHOD

A Markov model was constructed using data from the NIAGARA trial. Costs and utility were sourced from public databases and literature. Total costs, life-years, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) were evaluated. Sensitivity analysis assessed model robustness.

RESULTS

Compared to neoadjuvant chemotherapy alone, the combination of durvalumab with neoadjuvant chemotherapy results in an additional 0.68 QALY, with an incremental cost of $86,485.19. The ICER per QALY is $93,693.79. Sensitivity analysis demonstrated the robustness of the model.

CONCLUSION

From the perspective of U.S. payers, durvalumab combined with neoadjuvant chemotherapy is a cost-effective strategy compared to chemotherapy alone for treating operable MIBC.