Chemo Shortage Increases Treatment Costs by 16% for Head and Neck Cancer

Impacts of the chemotherapy shortage that started in 2023 led to increased treatment costs and administration.

The cisplatin shortage that occurred resulted in the use of alternative therapies for the treatment of head and neck cancers, which led to significant cost increases for patients and payers, according to findings from a study presented at the 2024 ASCO Quality Care Symposium.

The chemotherapy shortage started in 2023 and continued into 2024. Since then, research has been conducted to assess its impact on patient care and outcomes, among other factors.

“Drug shortages have become and 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,” Dr. Puneeth Indurlal, of the 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 result the problem of drug shortages.”

In this study, researchers assessed administration data from medical records and claims from 26 practices before (July 2022 to January 2023), during and after (September 2023 to March 2024) the chemotherapy shortage. In particular, researchers analyzed the trends and financial impact of shortages of cisplatin and other anti-cancer drugs to treat patients with head and neck cancers.

During this drug shortage, the use of cisplatin to treat head and neck cancers decreased by 15% compared with its use before the shortage. The lowest use was reported for June and July of 2023, during which there was a 60% decrease in the use of cisplatin.

The use of alternative chemotherapy drugs increased for head and neck cancers during the shortage period. Of note, the use of carboplatin increased by 40%, 5-fluorouracil increased by 5.3%, paclitaxel increased by 24% and Erbitux (cetuximab) increased by 15%. These trends corresponded with the decrease in cisplatin use, as more patients started treatment with carboplatin (with or without paclitaxel), 5-fluorouracil and Erbitux.

Of the patients who were treated with cisplatin during the shortage, 10% were shifted to treatment with another drug.

In the study’s abstract, researchers also noted that 5-fluorouracil was in short supply during this time, although it was less severe than the carboplatin shortage.

Once the shortage was over, the volumes of cisplatin recovered by 8% of use before the shortage, and use of carboplatin decreased to below shortage levels. The use of Erbitux was consistently 12% higher.

The increased use of Erbitux instead of cisplatin increased the total cost of treatment.

Regarding cost, the average price per administration was $14 for carboplatin, $18 for cisplatin, $22 for 5-fluorouracil, $16 for paclitaxel and $2,607 for Erbitux, as determined by the Medicare average sale price. Increasing the use of Erbitux instead of cisplatin increased the total cost of treatment per administration by 16%. This resulted in a 144-fold increase in costs on the administration level, thus impacting patient cost-sharing amounts and payer costs, according to the release.

“Cancer drug shortages in the United States most commonly occur with chemotherapy agents that are generic and expensive,” Dr. Julie R. Gralow, Chief Medical Officer and Executive Vice President of ASCO, said in a press release from the organization. “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 [Erbitux]), 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.”

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