Scientific Online Resource System

Annual for Hospital Pharmacy

Enfortumab vedotin for the treatment of patients with urothelial cancer after failure of the treatment with PD-1/PD-L1 inhibitor—cost-effectiveness analysis

Toni Vekov, Makreta Draganova, Nadia Veleva, Elena Daracheva, Valentina Belcheva, Jivko Kolev

Abstract

Introduction: Bladder cancer (BC) is one of the most common malignancies in industrialized countries. The incidence of BC increases with age and is almost 3 times more common in men than in women. The therapy in adult patients with locally advanced or metastatic BC who have previously received chemotherapy containing platinum and a PD-1/PD-L1 inhibitor requires the inclusion of enfortumab vedotin (EV) or docetaxel- or paclitaxel-based chemotherapy.

Aim: The aim of the study is to model local data on long-term costs and health benefits from the application of alternative health technologies for the treatment of patients with BC to decide which therapy has an advantage in terms of the ratio of therapeutic efficacy and cost-effectiveness.

Materials and Methods: Inputs in the prognostic model used were measured and evaluated as clinical endpoints in the EV-301 multicentre randomized clinical trial. The modelled data on future health benefits and costs after the end of the clinical trial are based on Markov’s model with three health conditions, one of which is absorbent.

Conclusion: Despite therapeutic superiority of enfortumab vedotin over chemotherapy (docetaxel, paclitaxel), it is not a cost-effective approach to treat patients with urothelial carcinoma after failure with PD-1/PD-L1 inhibitors. The only reason for this is its high price. The value of the cost-benefit ratio of enfortumab vedotin is around BGN 659,000/QALY and significantly exceeds the cost-effectiveness threshold (ICER ≤ BGN 50,000/QALY), which is equal to three times the gross domestic product per capita of the population in Bulgaria for the previous year.

Keywords

bladder cancer/locally advanced or metastatic/new therapies; enfortumab vedotin; chemotherapy/docetaxel or paclitaxel; cost-effectiveness analysis

Full Text


References

Антонова О, Белчева В. Съвременни подходи при лечение на рак на пикочен мехур. Годишник по болнична фармация. 2015;1(1):32-39.

Antonova O, Toncheva D, Grigorov E. Bladder cancer risk from the perspective of genetic

polymorphisms in the carcinogen metabolizing enzymes. J BUON. 2015;20(6):1397-1406.

WHO, International Agency for Research on Cancer, Bladder Cancer Factsheet, Global Cancer Observatory, 2020.

Национална болница по онкология. Български национален раков регистър 2016-2017, vol. 26, 2018.

Караиванова М, Пейчев Л, Георгиев Ст. Лекарствен справочник 2016. TEA Дизайн, 2016. ISBN: 978-619-90647-3-3

Powles T, Rosenberg J, Sonpavde G et al. Enfortumab Vedotin in Previously Treated Advanced Urothelial Carcinoma. N Engl J Med. 2021;384(12):1125-1135.

Garber A, Phelps C. Economic foundations of cost-effectiveness analysis. J Health Econ. 1997;16(1):1-31.

Grigorov E, Vaseva V, Getov I. Applied pharmacoeconomics – methodology, structuring and conducting of pharmacoeconomical studies, Journal of International Scientific Publications: Economy & Business. 2013;7(1):540-551.

Shtereva D. Types of methods of economic evaluations in the healthcare sector. Journal of International Scientific Publications: Economy & Business. 2010;4(4):4-11.

Petrylak D, Rosenberg J, Lee J et al. EV-301: A phase III trial in progress evaluating enfortumab vedotin versus chemotherapy in patients with locally advanced or metastatic urothelial carcinoma. Ann Oncol. 2019,30(9):IX75-IX76.

Carta A, Conversano C. On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers. Front Public Health. 2020. doi: 10.3389/fpubh.2020.569500.

Gui Y, Han S, Weng H et al. Cost-effectiveness analysis based on Markov model using TreeAge Pro software. Chinese Journal of Evidence-Based Medicine. 18(1):116-120.

European Commission, EUnetHTA. Joint Action 3, 2016-2020, https://es.europa.eu/health/technology_assessment/overview_en

Mitchell R, Bates P. Measuring health-related productivity loss. Popul Health Manag. 2011;14(2):93-98.

Hristov E, Ognyanov S, Deliyski T, Andreevska K, Burgazliev H, Grekova D, Dimitrova Z, Yordanov E, Rashkov D. Effect of Pharmacist Involvement on Patient Reporting of Adverse Drug Reactions in Bulgaria. J Adv Res Pharm Sci Pharmacol Interv. 2019;2(2):1-6.




DOI: http://dx.doi.org/10.14748/ahp.v8i1.8581

Refbacks

Article Tools
Email this article (Login required)
|