New Study Highlights Long-lasting Effects of Cancer Drug Shortages

New Research Will Be Presented at 2024 ASCO Quality Care Symposium

ASCO Perspective Quote

"Cancer drug shortages in the United States most commonly occur with chemotherapy agents that are generic and inexpensive. This study shows that switches to alternative regimens in patients with head and neck cancer during the 2023 cisplatin/carboplatin drug shortage crisis involved the use of more expensive substitutes (specifically the monoclonal antibody cetuximab), resulting in significant increases in cost of care for payers and patients. Whether switches made during the recent drug shortages will ultimately be shown to result in equivalent or possibly poorer outcomes remains to be seen." - Julie R. Gralow, MD, FACP, FASCO, ASCO Chief Medical Officer and Executive Vice President.

Study at-a-Glance

Focus	2023 cisplatin drug shortage's impact on the health care system
Population	People with head and neck cancer receiving chemotherapy at 26 oncology practices in The US Oncology Network
Main Takeaway	The 2023 cisplatin drug shortage led to an increased use of alternative drugs and higher costs for the health care system people with head and neck cancers.
Significance	Drug shortages can lead to treatment delays, interruptions in care, or changes in treatment plans. During a shortage, some patients may need to receive an alternative drug or treatment regimen, which may cause more side effects, may be less effective, or may cost more than the recommended treatment. In 2023, the chemotherapy drug cisplatin, which is available as a generic drug, was in shortage from February to August. Cisplatin is used to treat several types of cancer, including head and neck cancer. Chemotherapy use is common for people with this type of cancer, and before the shortage, cisplatin was the most used chemotherapy drug for these patients. Previously, there has only been anecdotal evidence about the impact of drug shortages on the health care system. This study aimed to better understand the specific effects of a critical drug shortage in a treatable cancer and to generate data-driven evidence of the anticipated impacts to care.

ALEXANDRIA, Va. - The cisplatin drug shortage in 2023 led to an increased use of alternative drugs and higher costs for people with head and neck cancers, according to new research that will be presented at the 2024 American Society of Clinical Oncology (ASCO) Quality Care Symposium, taking place September 27-28, 2024, in San Francisco, California.

About the Study

"Drug shortages have become an all-too-common occurrence in oncology care, disrupting patient treatment, impacting where and how health care providers spend their time, and causing broad-ranging effects on the health care system. These results show the multi-faceted consequences of drug shortages and serve to provide evidence in the call-to-action for all health care and participating supply chain stakeholders to resolve the problem of drug shortages," said lead study author Puneeth Indurlal, MD, MS, MBBS, The American Oncology Network, who was with The US Oncology Network when this work was conducted.

The researchers looked at the medical records and claims from 26 practices in The US Oncology Network from before the shortage (July 2022 to January 2023), during the shortage (February 2023 to August 2023), and after the shortage (September 2023 to March 2024).

Key Findings

• The use of cisplatin decreased by 15% during the shortage for people with head and neck cancer. The lowest use of the drug was in June and July 2023, which saw a 60% decrease in use compared to before the shortage.
• Other chemotherapy drugs were used more frequently, including carboplatin (40% increase in use), paclitaxel (24% increase), and 5-fluorouracil (5.3% increase), during the shortage. All 3 drugs have generic options available. The targeted therapy drug cetuximab (Erbitux) was also used more during the shortage, with an increased use of 15%.
• Of the patients who were already receiving cisplatin before the shortage, 10% were shifted to receive a different drug during the shortage due to a complete lack of availability. For patients who had not yet started treatment before the shortage, they received carboplatin (with or without paclitaxel), cetuximab, or 5-fluorouracil instead of cisplatin.
• Of all the alternative drugs used during the shortage, cetuximab cost the most, with an average cost of $2,607 per dose.
  • In comparison, the average cost was $18 for cisplatin, $14 for carboplatin, $16 for paclitaxel, and $22 for 5-fluorouracil. Greater use of cetuximab in particular led to a 16% increase in total cost, and the per infusion costs were 144 times higher. This resulted in higher costs for both patients and health insurance providers.
  • Cancer treatment with a specific drug regimen should usually not be switched after treatment with it has begun, as there is currently not enough evidence evaluating the effectiveness of such mixed regimens. Therefore, all the patients who started cetuximab during the shortage continued to receive the more expensive drug even when the cisplatin shortage ended.

Next Steps

The researchers will seek to learn more about how drug shortages affect cancer care, including whether the shortage led to delays in treatment or to patients stopping treatment. They also plan to study how the shortage affected patient outcomes and how the increased costs affected the performance of the cancer care system.

This study did not receive funding.

View the full abstract

View author disclosures

View the News Planning Team disclosures: https://society.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2024-QCS-NPT-Disclosures.pdf

ATTRIBUTION TO THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY QUALITY CARE SYMPOSIUM IS REQUESTED IN ALL COVERAGE.

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