Study reveals ‘multifaceted consequences’ of cisplatin shortage
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Key takeaways:
- The cisplatin shortage forced many patients with head and neck cancer to use alternative therapies.
- Treatment costs increased, largely due to the higher price of cetuximab.
Findings presented at ASCO Quality Care Symposium provided new insights into the effects last year’s cisplatin shortage had on patients with head and neck cancer.
Cisplatin use declined significantly, particularly in June and July 2023, and several patients who had started regimens that included the agent had to switch to alternative treatments.
Use of carboplatin, paclitaxel and cetuximab (Erbitux, Eli Lilly) increased sharply during the same time. Overall treatment costs subsequently increased, a rise driven largely cetuximab use.
“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,” Puneeth Indurlal, MD, MS, MBBS, vice president of practice operations at American Oncology Network, said in an ASCO press release. “These results show the multifaceted 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.”
Background and methods
The FDA reported shortages of cisplatin and carboplatin between February and August of last year.
A National Comprehensive Cancer Network survey of U.S. cancer centers conducted last May showed 70% did not have enough cisplatin.
Indurlal — who practiced with The US Oncology Network at the time the study was conducted — and colleagues evaluated medical records for patients with head and neck cancer from 26 practices within the network to assess the effects of the cisplatin shortage.
Utilization trends and financial impact during three periods — before the shortage (July 2022 to January 2023), during the shortage and after the shortage (September 2023 to March of this year) — served as the primary endpoints.
Results and next steps
Cisplatin use decreased 15% during the shortage compared with before it, with the steepest reduction — a 60% decline — observed in June and July 2023.
The shortage forced 10% of patients who already had started cisplatin chemotherapy to change to an alternative treatment.
Use of other chemotherapy agents, meanwhile, increased during the shortage period. These included carboplatin (40% increase), paclitaxel (24% increase) and 5-FU (5.3% increase). Use of cetuximab — an EGFR inhibitor — increased 15% during that time.
After the shortage, cisplatin use “rebounded by 8% of pre-shortage use” but carboplatin use declined to below pre-shortage levels, researchers wrote.
Use of cetuximab, however, “remained consistently 12% higher” in the post-shortage period, researchers wrote.
The average cost of cisplatin is $18 per administration, according to study authors.
Cetuximab had the highest average cost — $2,607 per dose — of all alternative drugs used during the shortage. In comparison, average costs per dose ranged from $14 for carboplatin, $16 for paclitaxel and $22 for 5-FU.
The increased use of cetuximab contributed to a 16% increase in overall costs during the shortage, including a 144-fold increase in per-infusion costs.
Individuals who started cetuximab during the shortage likely continued the treatment afterward, resulting in continued higher costs, Indurlal and colleagues concluded.
Researchers plan to investigate if the drug shortage caused treatment delays and stoppages, if it impacted patient outcomes and how cost increases affected cancer centers.
“Cancer drug shortages in the United States most commonly occur with chemotherapy agents that are generic and inexpensive,” Julie R. Gralow, MD, FACP, FASCO, ASCO chief medical officer and executive vice president, said in the press release. “This study shows that switches to alternative regimens [for] 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.”
References:
- ASCO. New study highlights long-lasting effects of cancer drug shortages (press release). Available at: https://society.asco.org/about-asco/press-center/news-releases/new-study-highlights-long-lasting-effects-cancer-drug. Published Sept. 23, 2024. Accessed Sept. 26, 2024.
- Indurlal P, et al. Abstract 1. Presented at: ASCO Quality Care Symposium; Sept. 27-28, 2024; San Francisco.
Collapse
Indurlal P, et al. Abstract 1. Presented at: ASCO Quality Care Symposium; Sept. 27-28, 2024; San Francisco.
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