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# Perioperative enfortumab vedotin and pembrolizumab in cisplatin-ineligible bladder cancer
- URL: https://www.coios.me/perioperative-enfortumab-vedotin-and-pembrolizumab-in/
- Published: 2026-10-23T13:14:11.000Z
- Updated: 2026-10-24T06:06:04.000Z
- Description: In a Markov model, perioperative enfortumab vedotin plus pembrolizumab cost $72,460 per QALY gained versus radical cystectomy alone.
- Author: Daniel Ryan
- Tags: Data, models and systems, Value in health, Cancer, United States, #peer-reviewed, #new, #item, #source-2026-10, #score-74

The study modelled cost-effectiveness of perioperative enfortumab vedotin plus pembrolizumab with radical cystectomy in muscle-invasive bladder cancer. A decision-analytic Markov model simulated 10,000 cisplatin-ineligible patients, aged 73 years at baseline, 77.9% male. The horizon was 10 years from a Medicare payer perspective, with efficacy from the KEYNOTE-905/EV-303 trial. Adding perioperative therapy raised survival from 4.12 to 5.63 life-years and from 3.20 to 4.51 QALYs. Total costs rose from $317,513 to $412,160 per patient. Post-progression treatment costs fell from $238,729 to $12,578, and the ICER was $72,460 per QALY. Long-term outcomes are extrapolated from a median follow-up of 25.6 months.

*Why it is interesting: Cisplatin-ineligible patients previously proceeded to radical cystectomy alone, so this prices a new option. Higher upfront drug costs are only partly offset by lower post-progression spending.*

Source

[JAMA Network Open, 20 October 2026](https://doi.org/10.1001/jamanetworkopen.2026.40370?ref=coios.me)

Paper

Cost-Effectiveness of Perioperative Enfortumab Vedotin and Pembrolizumab for Bladder Cancer

Authors

Su ZT, Garman TS, Rivera Lopez CA, Talwar R, Chelluri R, Johnson BA et al.

DOI

10.1001/jamanetworkopen.2026.40370

Type

Peer-reviewed article

Design

Decision-analytic Markov cost-utility model, 10 000 simulated cisplatin-ineligible MIBC patients (baseline age 73), Medicare perspective, 10-year horizon, efficacy from KEYNOTE-905/EV-303 (median follow-up 25.6 months); analyses Oct 2025-Aug 2026

Verdict

New finding

Driver

[Value in health](https://www.coios.me/d-health-economics/)

Driver

[Cancer](https://www.coios.me/d-cancer/)

Free full text

[Free to read at the publisher](https://doi.org/10.1001/jamanetworkopen.2026.40370?ref=coios.me)