{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:17:24Z","timestamp":1784297844610,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Recent phase III programs, EV-302 and CheckMate-901, showed that enfortumab vedotin plus pembrolizumab (EV\u202f+\u202fP) and nivolumab with gemcitabine-cisplatin (N\u202f+\u202fGC) deliver superior clinical outcomes when used as initial therapy for advanced urothelial cancer. What remains uncertain is their relative economic value when assessed under Chinese and US payer conditions. To address this gap, we compared the value for money of EV\u202f+\u202fP versus N\u202f+\u202fGC as first-line management for la\/mUC from the perspectives of healthcare payers in China and the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a model-based economic evaluation using a time-dependent state-transition framework implemented in TreeAge Pro (2022). Health benefits were measured as quality-adjusted life-years (QALYs) derived from health-state utilities, and comparative value was expressed as incremental cost-effectiveness ratios (ICER). The robustness of the model was assessed through one-way sensitivity analysis (OWSA) to evaluate the impact of key parameter uncertainties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the US, EV\u202f+\u202fP cost $1,863,624.32 and provided 3.34 QALYs, while N\u202f+\u202fGC cost $881,979.07 for 2.36 QALYs, resulting in an ICER of $1,001,626.19 per QALY, exceeding the $150,000\/QALY threshold. In China, EV\u202f+\u202fP cost $485,374.69 and provided 2.95 QALYs, compared to $203,811.61 for 2.15 QALYs with N\u202f+\u202fGC, yielding an ICER of $351,960.68\/QALY, above the $40,451.64\/QALY threshold. Therefore, N\u202f+\u202fGC is the more cost-effective first-line strategy in both countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Under current pricing and reimbursement assumptions, N\u202f+\u202fGC is economically preferable to EV\u202f+\u202fP as a first-line strategy for la\/mUC in both the US and China. EV\u202f+\u202fP may warrant consideration only in tightly selected scenarios or with substantial coordinated price reductions and policy changes. Meanwhile, it should be noted that due to the inherent limitations of the indirect comparison method between drugs, the conclusions of this study should be regarded as exploratory analysis results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1723784","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:52:53Z","timestamp":1770879173000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["First-line enfortumab vedotin-pembrolizumab versus nivolumab plus gemcitabine-cisplatin in metastatic urothelial cancer: a cost-effectiveness study"],"prefix":"10.3389","volume":"14","author":[{"given":"Haojie","family":"Ying","sequence":"first","affiliation":[{"name":"The Fourth School of Clinical Medicine of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Fu","sequence":"additional","affiliation":[{"name":"Institute of Digital Traditional Chinese Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1016\/S0140-6736(18)30207-1","article-title":"Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial","volume":"391","author":"Kudo","year":"2018","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S193","DOI":"10.5489\/cuaj.1195","article-title":"Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder 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