Understanding Enfortumab Vedotin (Padcev)
Enfortumab vedotin, marketed under the brand name Padcev, is a targeted cancer therapy known as an antibody-drug conjugate (ADC) [1.5.2]. It is primarily used to treat adults with locally advanced or metastatic urothelial cancer (mUC), the most common type of bladder cancer [1.5.4, 1.5.2]. The U.S. Food and Drug Administration (FDA) has approved its use both as a standalone treatment for patients who have previously received platinum-based chemotherapy and immunotherapy, and in combination with pembrolizumab (Keytruda) as a first-line treatment option [1.10.1, 1.10.3].
How It Works
This medication works by targeting a protein called Nectin-4, which is highly expressed on the surface of urothelial cancer cells [1.5.2]. The antibody component of Padcev binds to Nectin-4, allowing the linked chemotherapy drug, monomethyl auristatin E (MMAE), to enter and kill the cancer cell directly [1.5.3]. This targeted approach helps to spare healthy cells, though side effects can still occur. The standard dosage is 1.25 mg/kg, administered as an intravenous (IV) infusion on days 1, 8, and 15 of a 28-day cycle [1.8.2].
The Price of Treatment: A Detailed Breakdown
The cost of enfortumab vedotin is significant, representing a substantial financial consideration for patients and healthcare systems. The price a patient pays is influenced by multiple variables, including the drug's list price, treatment duration, patient's weight, and insurance coverage [1.6.1, 1.6.3].
Wholesale and Per-Cycle Costs
As of March 2025, the Wholesale Acquisition Cost (WAC) for Padcev is listed as:
- $2,809.00 for a 20 mg single-dose vial [1.3.2, 1.3.3, 1.3.5].
- $4,213.50 for a 30 mg single-dose vial [1.3.2, 1.3.3, 1.3.5].
These prices do not reflect the final cost to the patient. Studies analyzing the economics of the treatment provide a clearer picture of expenses per cycle. One analysis estimates the cost of Padcev monotherapy at approximately $17,718 per 28-day cycle [1.2.2]. For the combination therapy with pembrolizumab, the cost for a 28-day cycle rises to about $24,547 [1.2.1]. Another study calculated a cost of over $30,000 per 28-day cycle for a 70-kg person [1.2.4].
Factors Influencing Patient Costs
Several key factors determine the out-of-pocket expenses for a patient receiving enfortumab vedotin:
- Dosage and Patient Weight: Since dosing is weight-based (1.25 mg/kg), a patient's weight is a primary driver of the total drug amount needed and, therefore, the cost [1.6.1, 1.6.3].
- Treatment Duration: Padcev is administered until disease progression or unacceptable toxicity occurs, meaning the total cost accumulates over many months [1.8.2].
- Insurance Coverage: The patient's final cost heavily depends on their health insurance plan, including deductibles, copayments, and coinsurance. Patients on Medicare with no supplemental coverage could face 20% cost-sharing with no annual out-of-pocket limit [1.11.2].
- Combination Therapy: When used with pembrolizumab, the total cost increases significantly. The combination regimen (EV+P) has a total cost estimated at $752,637 over a patient's lifetime, compared to $80,874 for traditional chemotherapy [1.2.3].
- Infusion Costs: As an IV medication, there are additional costs associated with administration in an infusion center, which are not included in the drug's list price [1.2.4].
Comparison with Alternative Treatments
While highly effective, the cost of enfortumab vedotin is considerably higher than other treatments for urothelial cancer. Economic analyses have consistently found that the regimen is not cost-effective at its current price point when measured against common willingness-to-pay thresholds [1.11.2, 1.11.3].
| Treatment Regimen | Estimated Total Cost (First Year or Lifetime) | Efficacy (Median Overall Survival) |
|---|---|---|
| Enfortumab Vedotin + Pembrolizumab | $561,947 (1-year, commercial plan) [1.7.1]; $752,637 (lifetime) [1.2.3] | 31.5 months [1.9.2] |
| Platinum-Based Chemotherapy | $80,874 (lifetime) [1.2.3] | 16.1 months [1.9.2] |
| Platinum-Based Chemotherapy + Avelumab | $175,200 (1-year, commercial plan) [1.7.1] | ~21.7 months (with Nivolumab, similar immunotherapy) [1.11.2] |
| Sacituzumab Govitecan | $63,198 (total acquisition cost for median treatment duration) [1.2.4] | 10.9 months [1.2.4] |
Financial Assistance and Support Programs
To help mitigate the high cost, the manufacturer offers support programs. The PADCEV Copay Assistance Program is available for eligible patients with private commercial insurance. This program can lower out-of-pocket costs to as little as $5 per dose, with an annual maximum benefit of $25,000 [1.4.1, 1.4.2]. For uninsured or underinsured patients, the PADCEV Patient Assistance Program may provide the medication at no cost if eligibility requirements are met [1.4.2, 1.4.4]. Other independent organizations like the Patient Access Network (PAN) Foundation and the HealthWell Foundation also offer co-pay assistance for eligible individuals [1.4.3].
Conclusion
How much does enfortumab vedotin cost in the US? The answer is complex. While the list price is high, the final cost to the patient varies widely based on weight, insurance, and treatment duration. The per-cycle cost is estimated to be between $17,000 and $30,000, and it represents a significant advancement in treating urothelial cancer, offering substantial survival benefits over older standards of care [1.9.2, 1.2.2]. However, its high price raises serious concerns about cost-effectiveness and patient access [1.11.2]. Financial assistance programs are crucial resources that can help eligible patients manage this financial burden and access this life-extending therapy. Patients are encouraged to speak with their healthcare provider and explore these support options.
Disclaimer: This article provides information based on available data and is not medical or financial advice. Consult with healthcare professionals and insurance providers for personalized information.
Padcev Support Solutions [1.4.2]
