Costs of generic vs. branded nab-paclitaxel (nP) during first-line (1L) treatment of metastatic pancreatic adenocarcinoma (mPDAC) with gemcitabine + nab-paclitaxel (GnP) in a real-world commercial database.

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Background: In 2013, the FDA approved GnP for 1L treatment of mPDAC. The total cost of care (TCoC) to payers during treatment is driven by the cost of nP, which first faced competition from generics in April 2022. We examined cost per generic vs. branded nP claim and cost per patient (pt) before and after generic entry. Methods: This retrospective observational study utilized Optum Market Clarity claims + EHR data. Inclusion criteria were: adult pts diagnosed with mPDAC between January 1, 2015 and May 31, 2023; initiated 1L GnP (index date) -14 to +90 days from diagnosis; 6 months pre-index enrollment. Claims were grouped into branded vs. generic based on NDC. For per-pt-per-month (PPPM) analyses, pts were required to have ≥30 days post-index enrollment and no nP claims missing NDCs. Pts were grouped into 1) branded pts with all nP claims for the branded NDC, and 2) generic pts with all claims for generic NDCs. TCoC, inpatient, outpatient, and chemotherapy drug cost to payers were calculated. The full study period and the period of generic entry beginning April 1, 2022 were examined. Results: Costs for branded vs. generic nP claims and GnP pts for 1L treatment initiated April 1, 2022 and after are shown (Table). The mean cost of generic claims was affected by outliers and was more than twice that of branded. The median nP claim cost, less affected by outliers, was still $2,408 greater for generic vs. branded. Costs for branded nP claims were similar before and after generic entry (not shown). 20 1L GnP pts had only branded nP claims, 24 had only generic, and 156 had mixed or were missing ≥1 NDC. PPPM mean TCoC was approximately twice as high for generic vs. branded. Medians were more similar, with generic median $2,037 higher vs. branded. Differences were driven by drug cost; other inpatient and outpatient costs were similar between the two groups (not shown). Costs of branded GnP pts before and after generic entry were similar (not shown). Conclusions: Publicly available prices for branded nP are $1,673 vs. $1,460 for generic per 100mg. In real-world data, we found generic nP costs per claim and PPPM tended to be higher than branded. While GnP is accepted by payers and clinicians as a standard 1L regimen for mPDAC, its real-world drug cost is at the level of branded therapy, despite generic availability. Future research should evaluate this finding as more post-generic-entry data becomes available.

Branded vs generic costs.