The U.S. healthcare system faced significant challenges in 2023 as a widespread cisplatin shortage forced oncologists to modify treatment approaches for head and neck cancer patients, leading to increased use of alternative therapies and higher treatment costs, according to new research presented at the 2024 ASCO Quality Care Symposium.
During the shortage period from February through August 2023, oncology centers reported a 15% reduction in cisplatin usage. This decline was offset by substantial increases in alternative treatments: carboplatin use rose by 40%, paclitaxel by 24%, cetuximab by 15%, and fluorouracil by 5%.
"We observed significant changes in the overall administration patterns in several drugs used for routine treatment of [patients with] head and neck cancer," reported Jody S. Garey, PharmD, director of Clinical Analytics & Data Science at McKesson. The timing of these changes became most apparent in May 2023, approximately four months after the initial shortage announcement.
Impact on Treatment Protocols
The shortage particularly affected curative-intent treatments, where physicians were forced to make difficult therapeutic adjustments. In the palliative setting, researchers observed increased use of cetuximab and paclitaxel, while carboplatin and fluorouracil usage decreased, likely reflecting efforts to preserve these agents for curative cases.
The shift toward alternative treatments raised concerns about guideline adherence. The most significant increase in curative-intent use was seen with carboplatin plus paclitaxel, which carried only a Category 2b recommendation in the National Comprehensive Cancer Network (NCCN) Guidelines at the time, indicating less optimal care compared to standard cisplatin-based regimens.
Financial Implications
The shortage triggered substantial cost increases that persisted even after supply issues resolved. Analysis of Medicare-allowable reimbursements revealed striking cost differences among alternative treatments:
- Basic chemotherapy agents (cisplatin, carboplatin, paclitaxel): $14-18 per administration
- Combination therapies: $30-36 per administration
- Cetuximab: $2,607 per administration
Patient cost-sharing varied significantly based on insurance coverage. Under Medicare without secondary coverage, out-of-pocket costs ranged from $2.80 to $521.40 per administration. For commercial insurance plans with typical deductibles and coinsurance, patient responsibility could reach over $3,000 for cetuximab treatments.
Broader Healthcare System Impact
The cisplatin shortage occurred during a particularly challenging period for the U.S. healthcare system, which experienced 309 active drug shortages in the second quarter of 2023 – approaching the historical high of 320 shortages. An American Society of Health-System Pharmacists survey revealed that 57% of members reported "critically impactful" chemotherapy shortages during this period.
"Drug shortages endanger the healthcare system," emphasized Dr. Garey, calling for collaborative action among stakeholders. "It's critical that as an oncology community, we continue to investigate and report the impact of drug shortages... to work toward a long-term solution to end drug shortages."
