{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:29:28Z","timestamp":1792553368859,"version":"4.5.0"},"reference-count":24,"publisher":"Harborside Press, LLC","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    For patients with cisplatin-eligible clinically localized muscle-invasive bladder cancer (MIBC), cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) has long been the standard of care. In recent years, immune checkpoint inhibitors have transformed this paradigm. Adjuvant nivolumab was shown to extend disease-free and overall survival compared with placebo for patients at high risk for disease recurrence after RC (CheckMate 274 trial) and has become established as the new standard treatment. More recently, adding durvalumab to neoadjuvant gemcitabine\/cisplatin (GC) and as adjuvant monotherapy (\u201cperioperative\/sandwich\u201d immunotherapy) in cisplatin-eligible MIBC was shown to improve event-free and overall survival (NIAGARA trial). Herein, we evaluated the cost-effectiveness of adopting upfront, perioperative durvalumab for treating cisplatin-eligible MIBC.\n                    <jats:bold>Methods:<\/jats:bold>\n                    We developed a decision-analytic Markov model using efficacy and safety data from the NIAGARA trial comparing neoadjuvant GC + durvalumab followed by RC and adjuvant durvalumab (\u201cdurvalumab\u201d) versus neoadjuvant GC followed by RC alone (\u201ccomparison\u201d). In the comparison arm, patients with residual disease after NAC were modeled to receive adjuvant nivolumab, with associated survival and quality-of-life benefits incorporated using efficacy data from the CheckMate 274 trial. We calculated life years, quality-adjusted life years (QALYs), and direct medical costs from a US Medicare payer perspective over a 5-year time horizon. Scenario, one-way sensitivity, and probabilistic sensitivity analyses were performed.\n                    <jats:bold>Results:<\/jats:bold>\n                    The durvalumab arm achieved greater life years (3.85 vs 3.81) and QALYs (3.05 vs 3.01) than the comparison arm. Higher upfront treatment costs from adding perioperative durvalumab were offset by greater reductions in postprogression treatment costs, resulting in lower total costs ($567,215 vs $592,368). Therefore, the durvalumab arm dominated comparison. Results were highly robust across extensive sensitivity analyses.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    In the United States, adding perioperative durvalumab to neoadjuvant GC for cisplatin-eligible MIBC treatment is likely life-extending and cost-effective compared with the current standard treatment of cisplatin-based NAC followed by risk-adapted adjuvant nivolumab.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2025.7129","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T21:08:35Z","timestamp":1774300115000},"page":"172-178","source":"Crossref","is-referenced-by-count":2,"title":["Cost-Effectiveness of Perioperative Durvalumab With Neoadjuvant Gemcitabine\/Cisplatin in Muscle-Invasive Bladder Cancer Treatment"],"prefix":"10.6004","volume":"24","author":[{"given":"Zhuo Tony","family":"Su","sequence":"first","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella S.","family":"Florissi","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne E.","family":"Geller","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burles A.","family":"Johnson III","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean H.","family":"Hoffman-Censits","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"},{"name":"Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil H.","family":"Patel","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"},{"name":"Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Townsend","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Yale School of Public Health, New Haven, CT"},{"name":"Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT"},{"name":"Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT"},{"name":"Program in Microbiology, Yale University, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah M.","family":"Hahn","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"},{"name":"Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max R.","family":"Kates","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"},{"name":"Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"N Engl J Med","first-page":"2102","article-title":"Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma","volume":"384","author":"Bajorin DF","year":"2021","unstructured":"Bajorin DF, Witjes JA, Gschwend JE,  Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma. N Engl J Med 2021;384:2102\u20132114."},{"key":"B2","series-title":"J Clin Oncol","first-page":"15","article-title":"Adjuvant nivolumab in high-risk muscle-invasive urothelial carcinoma: expanded efficacy from CheckMate 274","volume":"43","author":"Galsky MD","year":"2025","unstructured":"Galsky MD, Witjes JA, Gschwend JE,  Adjuvant nivolumab in high-risk muscle-invasive urothelial carcinoma: expanded efficacy from CheckMate 274. J Clin Oncol 2025;43:15\u201321."},{"key":"B3","series-title":"N Engl J Med","first-page":"875","article-title":"Enfortumab vedotin and pembrolizumab in untreated advanced urothelial cancer","volume":"390","author":"Powles T","year":"2024","unstructured":"Powles T, Valderrama BP, Gupta S,  Enfortumab vedotin and pembrolizumab in untreated advanced urothelial cancer. N Engl J Med 2024;390:875\u2013888."},{"key":"B4","series-title":"N Engl J Med","first-page":"1773","article-title":"Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer","volume":"391","author":"Powles T","year":"2024","unstructured":"Powles T, Catto JWF, Galsky MD,  Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer. N Engl J Med 2024;391:1773\u20131786."},{"key":"B5","article-title":"NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2.2025","author":"Flaig TW","unstructured":"Flaig TW, Spiess PE, Abern MR,  NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2.2025. Accessed October 21, 2025. To view the most recent version, visit https:\/\/www.nccn.org"},{"key":"B6","series-title":"J Urol","first-page":"1166","article-title":"Financial toxicity among patients with bladder cancer: reasons for delay in care and effect on quality of life","volume":"199","author":"Casilla-Lennon MM","year":"2018","unstructured":"Casilla-Lennon MM, Choi SK, Deal AM,  Financial toxicity among patients with bladder cancer: reasons for delay in care and effect on quality of life. J Urol 2018;199:1166\u20131173."},{"key":"B7","series-title":"Eur Urol Oncol","first-page":"396","article-title":"Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action","volume":"4","author":"Bhanvadia SK","year":"2021","unstructured":"Bhanvadia SK, Psutka SP, Burg ML,  Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action. Eur Urol Oncol 2021;4:396\u2013404."},{"key":"B8","series-title":"Cancer Epidemiol Biomarkers Prev","first-page":"1304","article-title":"Medical care costs associated with cancer survivorship in the United States","volume":"29","author":"Mariotto AB","year":"2020","unstructured":"Mariotto AB, Enewold L, Zhao J,  Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol Biomarkers Prev 2020;29:1304\u20131312."},{"key":"B9","series-title":"Eur Urol","first-page":"536","article-title":"The financial burden of localized and metastatic bladder cancer","volume":"87","author":"Scilipoti P","year":"2025","unstructured":"Scilipoti P, Moschini M, Li R,  The financial burden of localized and metastatic bladder cancer. Eur Urol 2025;87:536\u2013550."},{"key":"B10","series-title":"Value Health","first-page":"3","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"25","author":"Husereau D","year":"2022","unstructured":"Husereau D, Drummond M, Augustovski F,  Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health 2022;25:3\u20139."},{"key":"B11","series-title":"Eur Urol","first-page":"17","article-title":"European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2023 guidelines","volume":"85","author":"Alfred Witjes J","year":"2024","unstructured":"Alfred Witjes J, Max Bruins H, Carri\u00f3n A,  European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2023 guidelines. Eur Urol 2024;85:17\u201331."},{"key":"B12","series-title":"N Engl J Med","first-page":"796","article-title":"Updating cost-effectiveness\u2014the curious resilience of the $50,000-per-QALY threshold","volume":"371","author":"Neumann PJ","year":"2014","unstructured":"Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness\u2014the curious resilience of the $50,000-per-QALY threshold. N Engl J Med 2014;371:796\u2013797."},{"key":"B1","series-title":"N Engl J Med","first-page":"2102","article-title":"Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma","volume":"384","author":"Bajorin DF","year":"2021","unstructured":"Bajorin DF, Witjes JA, Gschwend JE,  Adjuvant nivolumab versus placebo in muscle-invasive urothelial carcinoma. N Engl J Med 2021;384:2102\u20132114."},{"key":"B2","series-title":"J Clin Oncol","first-page":"15","article-title":"Adjuvant nivolumab in high-risk muscle-invasive urothelial carcinoma: expanded efficacy from CheckMate 274","volume":"43","author":"Galsky MD","year":"2025","unstructured":"Galsky MD, Witjes JA, Gschwend JE,  Adjuvant nivolumab in high-risk muscle-invasive urothelial carcinoma: expanded efficacy from CheckMate 274. J Clin Oncol 2025;43:15\u201321."},{"key":"B3","series-title":"N Engl J Med","first-page":"875","article-title":"Enfortumab vedotin and pembrolizumab in untreated advanced urothelial cancer","volume":"390","author":"Powles T","year":"2024","unstructured":"Powles T, Valderrama BP, Gupta S,  Enfortumab vedotin and pembrolizumab in untreated advanced urothelial cancer. N Engl J Med 2024;390:875\u2013888."},{"key":"B4","series-title":"N Engl J Med","first-page":"1773","article-title":"Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer","volume":"391","author":"Powles T","year":"2024","unstructured":"Powles T, Catto JWF, Galsky MD,  Perioperative durvalumab with neoadjuvant chemotherapy in operable bladder cancer. N Engl J Med 2024;391:1773\u20131786."},{"key":"B5","article-title":"NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2.2025","author":"Flaig TW","unstructured":"Flaig TW, Spiess PE, Abern MR,  NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2.2025. Accessed October 21, 2025. To view the most recent version, visit https:\/\/www.nccn.org"},{"key":"B6","series-title":"J Urol","first-page":"1166","article-title":"Financial toxicity among patients with bladder cancer: reasons for delay in care and effect on quality of life","volume":"199","author":"Casilla-Lennon MM","year":"2018","unstructured":"Casilla-Lennon MM, Choi SK, Deal AM,  Financial toxicity among patients with bladder cancer: reasons for delay in care and effect on quality of life. J Urol 2018;199:1166\u20131173."},{"key":"B7","series-title":"Eur Urol Oncol","first-page":"396","article-title":"Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action","volume":"4","author":"Bhanvadia SK","year":"2021","unstructured":"Bhanvadia SK, Psutka SP, Burg ML,  Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action. Eur Urol Oncol 2021;4:396\u2013404."},{"key":"B8","series-title":"Cancer Epidemiol Biomarkers Prev","first-page":"1304","article-title":"Medical care costs associated with cancer survivorship in the United States","volume":"29","author":"Mariotto AB","year":"2020","unstructured":"Mariotto AB, Enewold L, Zhao J,  Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol Biomarkers Prev 2020;29:1304\u20131312."},{"key":"B9","series-title":"Eur Urol","first-page":"536","article-title":"The financial burden of localized and metastatic bladder cancer","volume":"87","author":"Scilipoti P","year":"2025","unstructured":"Scilipoti P, Moschini M, Li R,  The financial burden of localized and metastatic bladder cancer. Eur Urol 2025;87:536\u2013550."},{"key":"B10","series-title":"Value Health","first-page":"3","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"25","author":"Husereau D","year":"2022","unstructured":"Husereau D, Drummond M, Augustovski F,  Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health 2022;25:3\u20139."},{"key":"B11","series-title":"Eur Urol","first-page":"17","article-title":"European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2023 guidelines","volume":"85","author":"Alfred Witjes J","year":"2024","unstructured":"Alfred Witjes J, Max Bruins H, Carri\u00f3n A,  European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2023 guidelines. Eur Urol 2024;85:17\u201331."},{"key":"B12","series-title":"N Engl J Med","first-page":"796","article-title":"Updating cost-effectiveness\u2014the curious resilience of the $50,000-per-QALY threshold","volume":"371","author":"Neumann PJ","year":"2014","unstructured":"Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness\u2014the curious resilience of the $50,000-per-QALY threshold. N Engl J Med 2014;371:796\u2013797."}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/24\/5\/article-p172.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/24\/5\/article-p172.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/24\/5\/article-p172.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:32:08Z","timestamp":1778754728000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/24\/5\/article-p172.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":24,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2025.7129","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}