Cost-effectiveness analysis of perioperative durvalumab plus platin-based chemotherapy in muscle invasive bladder cancer in Germany

BACKGROUND: The NIAGARA trial evaluated the efficacy of adding perioperative immunotherapy with durvalumab to standard gemcitabine/cisplatin chemotherapy in muscle-invasive bladder cancer (MIBC). In light of the rising financial burden associated with the treatment of urothelial carcinoma and the favorable clinical outcomes reported in the NIAGARA trial, we conducted a cost-effectiveness analysis based on clinical data to determine whether the inclusion of durvalumab is also justified from a socioeconomic standpoint in Germany. METHODS: We constructed a Markov model from the payer's perspective, incorporating clinical data derived from the NIAGARA trial. A Monte Carlo simulation was employed to determine the most cost-effective treatment strategy within the context of the German healthcare system. Lastly, we compared the incremental cost-effectiveness ratios (ICERs) of each treatment approach across varying willingness-to-pay (WTP) thresholds. RESULTS: The average cost associated with the standard of care (SoC) was €113,224, whereas the combination of durvalumab with gemcitabine/cisplatin resulted in an average cost of €126,386, leading to incremental costs of €13,162. The quality-adjusted life years (QALYs) gained were 3.16 for the SoC and 3.37 for the intervention, corresponding to an incremental effectiveness of 0.21 QALYs. The resulting ICER for the combination therapy was €61,006 per QALY. At a WTP threshold of €100,000, the addition of durvalumab to gemcitabine/cisplatin is the preferred treatment option, with a 76.5 % probability of being cost-effective. A significant proportion of the costs observed in the simulations was attributable to the expenses associated with subsequent therapies administered in the metastatic disease setting. CONCLUSION: Based on our findings, the incorporation of durvalumab into the perioperative treatment regimen constitutes a cost-effective strategy, primarily due to its potential to reduce the need for high-cost subsequent therapies in a proportion of patients. Consequently, an intensified therapeutic approach for MIBC may confer not only oncological advantages but also notable socioeconomic benefits.