Modeling the impact of avelumab use in patients with unresectable locally advanced or metastatic urothelial bladder carcinoma on cancer mortality reduction in Russia

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Abstract

Background. Published data (as of 2022) demonstrate that immune checkpoint inhibitors (ICIs) contribute to reducing cancer-related mortality among adult patients with locally advanced or metastatic urothelial carcinoma (la/mUC) in Russia.

Aim. To evaluate the impact of avelumab use in patients with la/mUC on cancer-related mortality reduction in Russia within a fixed budget allocated to this disease area. The study also updates previous estimates by incorporating changes in comparator drug prices, current treatment practices, and newly published epidemiological data from 2024.

Materials and methods. A three-year mathematical model was developed to describe treatment duration and outcomes for la/mUC, using overall survival and progression-free survival data from clinical trials. The model compares four scenarios: (1) historical practice (without ICIs), (2) current practice (with other ICIs), (3) full availability of avelumab for all eligible patients (proposed practice), and (4) a budget-neutral scenario where avelumab is used for part of the eligible population within a fixed budget.

Results. Up to 4,284 patients with la/mUC in Russia can initiate platinum-based chemotherapy annually. Transitioning from historical practice to current practice with other ICIs could prevent 536 deaths over three years, while switching from current practice to full avelumab availability could prevent up to 2,623 deaths. The cost per life saved was 7.9 million rubles in the first case and 7.2 million rubles in the second. Under a budget-neutral scenario, reallocating funds to provide maintenance avelumab therapy for only half of the eligible patients while retaining the use of atezolizumab, pembrolizumab, and nivolumab in earlier lines could also prevent deaths.

Conclusion. Introducing avelumab maintenance therapy for patients with la/mUC, also within the current budget framework, could reduce cancer mortality in Russia.

About the authors

Nikolay A. Avksentyev

Financial Research Institute, Ministry of Finance of the Russian Federation; Health and Market Access Consulting LLC

Author for correspondence.
Email: NA@health-ma.ru
ORCID iD: 0000-0002-2686-1330
Russian Federation, Build. 2, 3 Nastasinskiy Pereulok, Moscow 127006; Build. 1, 157 Volgogradskiy Prospekt, Moscow 109378

Yu. V. Makarova

Health and Market Access Consulting LLC

Email: NA@health-ma.ru
ORCID iD: 0000-0001-5129-8175
Russian Federation, Build. 1, 157 Volgogradskiy Prospekt, Moscow 109378

R. A. Zukov

Krasnoyarsk Regional Clinical Oncology Dispensary named after A.I. Kryzhanovsky; V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia

Email: NA@health-ma.ru
ORCID iD: 0000-0002-7210-3020
Russian Federation, 16 1-ya Smolenskaya St., Krasnoyarsk 660133; 1 Partizana Zheleznyaka St., Krasnoyarsk 660022

I. A. Andreyashkina

A.S. Loginov Moscow Clinical Research Center, Moscow Healthcare Department

Email: NA@health-ma.ru
ORCID iD: 0000-0003-2646-499X
Russian Federation, Build. 1, 1 Novogireyevskaya St., Moscow 111123

S. V. Averyanova

Regional Clinical Oncology Dispensary, Saratov

Email: NA@health-ma.ru
ORCID iD: 0009-0008-3023-4023
Russian Federation, 1V Smirnovskoye Ushchelye, Saratov 410053

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