Pembrolizumab is approved to treat patients with BCG unresponsive, high-risk, non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors who are ineligible for or have elected not to undergo cystectomy based on the results of the KEYNOTE-057 trial. However, pembrolizumab costs over $100,000 per year and has a significant rate of adverse effects. Compared to other treatment options, it is unknown if pembrolizumab is a cost-effective option in this setting.