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.
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