Cisplatin Shortage Shifted Chemo Utilization to Costlier Therapies for HNC

While cisplatin was in shortage, clinicians were forced to prescribe costlier alternatives for patients with head and neck cancer.

For the duration of an extended cisplatin shortage beginning February 10, 2023, utilization of chemotherapy shifted to the use of alternative therapies, including carboplatin and cetuximab (Erbitux), for patients with head and neck cancers, according to a study presented at the 2024 American Society of Clinical Oncology (ASCO) Quality Care Symposium.¹

Additionally, the increase of the overall cost of cisplatin has persisted even after the resolution of the shortage, highlighting a shift in treatment and a more pronounced financial burden for this patient group.

“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,” Puneeth Indurlal, MD, MS, MBBS, vice president of Practice Operations at The American Oncology Network, said in a press release on the study findings.²

Results from the ASCO presentation reveal that from May to August 2023, cisplatin use decreased by 15%, with increases of carboplatin by 40%, paclitaxel by 24%, cetuximab by 15%, and fluorouracil by 5% were observed over the same period. The investigators highlighted that these results were profound for new treatment starts in the same timeframe, with the majority of treatment changes occurring among patients undergoing treatment for curative intent.

Additionally, the average drug cost per administration has increased during and after the shortage period, an increase of more than $150 from July 2022 before the shortage to March 2024 after the shortage. Additionally, by March 2024, the average cost per administration had exceeded the August 2023 amount by roughly $25, despite the shortage having concluded more than 6 months prior.

Another key finding revealed that the use of category 2B National Comprehensive Cancer Network treatment recommendations in the absence of the category 1 recommended cisplatin alone or as a combination therapy often incurred greater impacts on the cost of care. The most pronounced impact is seen with cetuximab, which, on average, costs more than the cost of cisplatin per administration, with Medicare average sale price-based reimbursements of $18 for cisplatin and $2607 for cetuximab.

If patients had medicare without secondary insurance, cisplatin costs $3.60 and cetuximab costs $521.40. Additionally, if patients had commercial insurance with a $3000 deductible, 20% coinsurance, and $6000 out of pocket, cisplatin cost $21.60 and cetuximab cost $3025.68.

The study sought to describe the effects of the cisplatin shortage on The US Oncology Network practices for the treatment of patients with head and neck cancers. Specifically, the study aimed to assess chemotherapy utilization trends leading up to the shortage, during the shortage, and after the shortage concluded by overall use and new treatment starts as well as treatment intent. Additionally, the impact on costs was assessed, including payer impact and estimated patient responsibility.

The study period began in July 2022 and ended in March 2024. Pre-shortage occurred from July 2022 to January 2023, during the shortage occurred from February 2023 to August 2023, and post-shortage occurred from September 2023 to March 2024.

Chemotherapy evaluation was assessed through drug administration records from electronic health records (EHR). Costs associated with administered chemotherapy were evaluated through financial claims from a financial data warehouse.

Additionally, following the FDA announcement of the cisplatin shortage, cisplatin, paclitaxel, carboplatin, and fluorouracil were placed on the Fair Share Program, which is designed to allocate existing supply to practices based on historical use patterns while mitigating reactive product purchasing. Paclitaxel, fluorouracil, cisplatin, and carboplatin were kept on the Fair Share Program until April, September, and October 2023, and January 2024, respectively.

“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 the 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, chief medical officer and executive vice president of ASCO stated in the press release.

References

1. Indurlal P, Garey JS, Albaugh J, et al. Prescription predicament: unveiling the financial fallout of drug shortages. JCO Oncol Pract. 2024;20(suppl 10). doi:10.1200/OP.2024.20.10_suppl.1
2. New study highlights long-lasting effects of cancer drug shortages. News release. ASCO. September 23, 2024. Accessed October 15, 2024. https://shorturl.at/TUjIS