As the cost of cancer care hits all-time highs, payers are engaging oncologists in ways to make treatment as cost-efficient as possible. Clinical pathways, bundled payments, and physician performance incentives are but a few of the ways payers and physicians are working to improve treatment outcomes while reducing unnecessary expenses.
But there’s an aspect to cancer care costs that is largely overlooked — and, often, out of the hands of physicians at the patient-care level: shortages of common oncology drugs. In a survey report presented at this summer’s American Society of Clinical Oncology annual meeting, 83% of oncologists said they had been unable to prescribe a preferred chemotherapy agent in the past six months because of drug shortages. Often, when the drug they want can’t be found, oncologists turn to a more expensive agent.
Percentage of oncologists who experienced shortages with these drugs
Of the 210 oncologists who reported experiences with drug shortages, 38% substituted brand-name drugs for generic chemotherapy agents. Levoleucovorin (Fusilev), for instance, is a common substitution for leucovorin. Informally, some physicians told researchers that because of ongoing problems with the drug supply, they have begun to use the higher-cost drugs as their standard of care.
The methods used to deal with drug shortages not only drive up costs; respondents also acknowledged the potential for affecting treatment outcomes.
Source: Emanuel EJ, et al. Impact of oncology drug shortages. J Clin Oncol. 2013:31(suppl; abstr CRA6510).
The degree to which shortage protocols can minimize outlier costs is unknown, but there is clearly room for improvement. About 70% of respondents said they had received no formal guidance for drug allocation or substitution during shortages. Guidelines are more likely to exist at academic medical centers than at community-based practices. The lack of guidelines has implications for integrated health systems, ACOs, and payers working to make treatment cost-effective.