For metastatic MCC, avelumab treatment with previous PD-L1 assessment was cost-effective compared to best supportive care (ICER USD 44,885.06/QALY, WTP USD 53,333.33/QALY) and chemotherapy (ICER USD 42,993.06/QALY) [64] (Figure 5). The gene discussed is CD274; the disease is Merkel cell skin cancer.