Impact of Oncology Drug Shortages on Patient Therapy: Unplanned Treatment Changes

Daniel Jacob Becker · Sumit Talwar · Benjamin Philip Levy · Molly Thorn · Janna Roitman · Ronald H. Blum +2 more

59 citations0/0 files storedJournal of Oncology Practice

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Pharmaceutical Economics and Policy Advances in Oncology and Radiotherapy Economic and Financial Impacts of Cancer

Abstract

PURPOSE: Cancer drug shortages have increased considerably over the past 5 years, but quantitative analyses of the scope and effects are limited. We assessed the effects of drug shortages on outpatient medication use in a single New York City university hospital. METHODS: We examined pharmacy records for drug shortages, as defined by the American Society of Health-System Pharmacists. We assessed outpatient records for all patients with cancer treated with infusional antineoplastic medications from April 2010 to September 2010 and April 2011 to September 2011. RESULTS: Twelve medications were in shortage in 2010 and 22 in 2011. Drugs in shortage were used for 170 patients (50.8%) in 2010 and 241 patients (63.6%) in 2011 (P < .001). Of 235 patients treated in August-September 2011, there were 23(9.8%) documented therapy changes due to shortages, compared with zero changes in August-September 2010 (P < .001). Among patients treated in August-September 2010, 24 (11.4%) received paclitaxel and 19 (9.0%) received docetaxel. Among patients treated in August-September 2011, 11 (4.7%) received paclitaxel and 38 (16.2%) received docetaxel, a 69% decrease for paclitaxel and 80% increase for docetaxel from 1 year prior (P = .009, and P = .024, respectively). The estimated cost of a single treatment with paclitaxel for one patient with body-surface area 1.75 was $47.59 versus $858.39 for docetaxel, a 1,704% increase. Surveyed physicians frequently reported lower level evidence (30.4%) and increased risk of toxicity (34.8%) with alternative therapy in drug shortage cases. CONCLUSION: Oncology drug shortages affected the majority of patients in our center and increased at an alarming rate. Drug shortages have substantial economic costs and mandate treatment changes that may affect efficacy and toxicity.

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2011Impact of drug shortages on U.S. health systems 2009ASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems 2011The Shortage of Essential Chemotherapy Drugs in the United States 2010The Reality of Drug Shortages — The Case of the Injectable Agent Propofol 2004National survey of the impact of drug shortages in acute care hospitals 2003Managing drug shortages: Seven years’ experience at one health system

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