Perioperative Enfortumab Vedotin plus Pembrolizumab Cost-Effective in Cisplatin-Ineligible MIBC

This industry-funded US cost-utility analysis provides the first published economic evaluation of perioperative enfortumab vedotin plus pembrolizumab in cisplatin-ineligible or cisplatin-declining muscle-invasive bladder cancer, informing formulary and payer decisions after the November 2025 FDA approval.

enfortumab vedotinpembrolizumabnivolumabantibody-drug conjugatePD-1 inhibitormuscle-invasive bladder cancerurothelial carcinomacost-effectivenesscost-utility analysisMarkov modelKEYNOTE-905perioperative therapy Oncology Pharmacy

Background Information

Pembrolizumab plus enfortumab vedotin stands out as cost-effective for bladder cancer.

Patients with muscle-invasive bladder cancer (MIBC) who are ineligible or decline cisplatin have limited treatment options. Pembrolizumab with enfortumab vedotin (EV+Pem) offers a potential cost-effective alternative. EV+Pem improved quality-adjusted life-years (QALYs) by 2.56 and life-years by 3.08 compared to surgery with or without adjuvant nivolumab. The incremental cost-effectiveness ratio (ICER) was $52,117 per QALY. The treatment was cost-effective under a $100,000 per QALY threshold. Limitations include uncertainties in long-term survival projections and changing post-progression treatment patterns. EV+Pem provides a cost-effective treatment option for cisplatin-ineligible patients with MIBC.

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Authors: Hill-McManus D, Lai Y, Bensimon AG, Young J, Reeve K, Tzontcheva A, Squires P, Li H, Ramamurthy C, Mossanen M

Citation: Hill-McManus D, Lai Y, Bensimon AG, et al. Cost-effectiveness of perioperative pembrolizumab plus enfortumab vedotin for cisplatin-ineligible or cisplatin-declining patients with muscle-invasive bladder cancer in the United States. Journal of medical economics. 2026;29(1):2161-2176. doi:10.1080/13696998.2026.2713865

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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