Study shows cisplatin deficiency led to treatment alternatives for head and neck cancer that significantly increased costs

Alternative use of the monoclonal antibody cetuximab during the cisplatin shortage in the treatment of head and neck cancer resulted in an overall cost increase of 16%, resulting in a 144-fold increase in administrative-level costs, impacting payer and patient costs Share impacted amounts. These results, presented at the 2024 ASCO Quality Care Symposium,¹ come from a study by Puneeth Indurlal, MD, MS, MBBSVice President, Practice Operations at the American Oncology Network, and colleagues.

According to the US Food and Drug Administration (FDA), 138 drugs were in short supply in 2023, including 14 oncology drugs.² The ongoing shortage of oncology medicines is increasingly impacting clinical decision-making, patient outcomes and quality of life, as well as clinical trial enrollment and costs for payers and patients, as detailed in this study.

(Editor’s note: On June 28, 2024, the FDA announced that the supply of cisplatin now exceeds demand, ending a nationwide shortage that has hampered cancer treatment since the drug was found to be in short supply on February 10, 2023.³)

Study methodology

Researchers focused on drug administration data from medical records and claims for 26 practices in the US Oncology Network before the shortage (July 2022 to January 2023), during the shortage (February 2023 to August 2023), and after the shortage (September 2023). until March 2024). They then examined the impact of cisplatin deficiency on head and neck cancer treatment in these practices.

Key results

The researchers found that during the shortage period, the use of cisplatin for head and neck cancer fell by 15% compared to pre-shortage levels. The lowest usage occurred in June and July 2023, with a decrease of 60%. The 26 practices initially received their care through an allocation model and fair use guidelines from the Pharmacy & Therapeutics Committee of the US Oncology Network. During the shortage period, alternative chemotherapy drugs for head and neck cancer were used more frequently: carboplatin by 40%, paclitaxel by 24%, cetuximab by 15%, and fluorouracil by 5.3%.

The increasing use of alternative medications corresponded with the decline in cisplatin use, with new entrants switching to carboplatin (with or without paclitaxel), cetuximab, and fluorouracil. Ten percent of existing cisplatin recipients were switched to an alternative drug during the shortage period. At this time, fluorouracil was also in short supply, although less acute than cisplatin. After the drug shortage, cisplatin levels increased again by 8% of pre-shortage consumption, whereas carboplatin consumption fell below pre-shortage levels. Cetuximab use remained consistently 12% higher.

Additionally, when the researchers compared drug costs, they found that the average cost per administration was $2,607 for cetuximab, $22 for fluorouracil, $18 for cisplatin, $16 for paclitaxel, and $14 for carboplatin, based on the average selling price. Increased use of cetuximab instead of cisplatin resulted in an overall cost increase of 16%, resulting in a 144-fold increase in administrative-level costs, impacting payer costs and patient cost-sharing amounts.

Clinical significance

Julie R. Gralow, MD, FACP, FASCO

“In the United States, the most common cancer drug shortages are generic and low-cost chemotherapy drugs,” he said Julie R. Gralow, MD, FACP, FASCOChief Medical Officer and Executive Vice President of ASCO, in a statement. “This study shows that switching to alternative therapies in patients with head and neck cancer during the cisplatin/carboplatin drug shortage crisis in 2023 was associated with the use of more expensive substitutes (particularly the monoclonal antibody cetuximab), resulting in a significant increase in the cost of care for the payers and patients. It remains to be seen whether the changes made during the recent drug shortages will ultimately lead to equivalent or potentially worse outcomes.”

A call to action

In a statement about the results of the study, Dr. Indurlal, lead author of the study: “Drug shortages have become an all-too-common phenomenon in oncology care, affecting patient care and impacting where and how healthcare providers spend money.” Wasting time and having far-reaching implications for the healthcare system. These results demonstrate the multiple consequences of drug shortages and serve as evidence of a call to action for all healthcare and supply chain stakeholders to solve the problem of drug shortages.”

DISCLOSURE: Full disclosures from study authors can be found at coi.asco.org.

REFERENCES

1. Indurlal P, Garey JS, Albaugh J, et al: Prescribing problem: revealing the financial consequences of drug shortages. 2024 ASCO Quality Care Symposium. Summary 1. Presented September 27, 2024.

2. U.S. Food and Drug Administration: FDA Drug Shortages: Current and resolved drug shortages and discontinuations reported to FDA. Available at Accessed October 21, 2024.

3. U.S. Food and Drug Administration: FDA Roundup: June 28, 2024. Available at www.fda.gov/news-events/press-announcements/fda-roundup-june-28-2024. Accessed October 21, 2024.