Economic evaluation of Erdafitinib as a second-line treatment for advanced metastatic urothelial carcinoma: real-world data from the USA and prospective analysis from China

Metastatic urothelial carcinoma (mUC) is challenging to treat, with 37% of patients failing first-line therapy. Effective second-line treatments, like Erdafitinib, are crucial. This study evaluates the cost-effectiveness of Erdafitinib as a second-line treatment for mUC from US and Chinese payer perspectives. A Markov model was developed to project costs, life years, and quality-adjusted life years (QALYs) over lifetime. Data were collected from December 2023 to December 2024 for up-to-date estimates and were obtained from literature, health databases, and clinical trials.. The model was run to project long-term outcomes for both the United States and China. In the United States, Erdafitinib provides an additional 0.467 QALYs at a cost of $238,294.2 per QALY, which exceeds the $150,000 per QALY willingness-to-pay threshold. For China, when the cost of Erdafitinib is below $6.9 or $14 per milligram, there is a 90% probability that its incremental cost-effectiveness ratio will be below $38,223 or $84,966 per QALY, respectively. From the perspective of U.S. payers, Erdafitinib as a second-line treatment for mUC is not cost-effective. From the perspective of China, the cost-effectiveness of Erdafitinib is highly sensitive to its price, which could provide a reference for healthcare reimbursement negotiations.