Background:　The　management　of　muscle-invasive　bladder　cancer　(MIBC)　remains　challenging.　The　phase　III　NIAGARA　trial　showed　that　adding　durvalumab　to　neoadjuvant　chemotherapy　significantly　enhances　event-free　and　overall　survival　for　MIBC　patients.　However,　due　to　the　high　cost　of　durvalumab,　assessing　its　cost-effectiveness　is　crucial.Objective:　To　compare　the　cost-effectiveness　of　durvalumab　with　neoadjuvant　chemotherapy　versus　neoadjuvant　chemotherapy　alone　in　operable　MIBC,　from　the　perspective　of　U.S.　healthcare　payers.Design:　A　model-based　pharmacoeconomic　evaluation.Method:　A　Markov　model　was　constructed　using　data　from　the　NIAGARA　trial.　Costs　and　utility　were　sourced　from　public　databases　and　literature.　Total　costs,　life-years,　quality-adjusted　life　year　(QALY),　and　incremental　cost-effectiveness　ratio　(ICER)　were　evaluated.　Sensitivity　analysis　assessed　model　robustness.Results:　Compared　to　neoadjuvant　chemotherapy　alone,　the　combination　of　durvalumab　with　neoadjuvant　chemotherapy　results　in　an　additional　0.68　QALY,　with　an　incremental　cost　of　$86,485.19.　The　ICER　per　QALY　is　$93,693.79.　Sensitivity　analysis　demonstrated　the　robustness　of　the　model.Conclusion:　From　the　perspective　of　U.S.　payers,　durvalumab　combined　with　neoadjuvant　chemotherapy　is　a　cost-effective　strategy　compared　to　chemotherapy　alone　for　treating　operable　MIBC.