Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR

Lynn Huynh, Todor Totev, Francis Vekeman, Maureen P. Neary, Mei S. Duh, Al B Benson III

Research output: Contribution to journalArticle

Abstract

Aims: To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor’s perspective. Materials and methods: Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. Results: The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p =.03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p =.01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p =.02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. Limitations: The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients. Conclusions: Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.

Original languageEnglish (US)
Pages (from-to)945-951
Number of pages7
JournalJournal of Medical Economics
Volume20
Issue number9
DOIs
StatePublished - Sep 2 2017

Fingerprint

Octreotide
Carcinoid Tumor
Diarrhea
Neuroendocrine Tumors
Costs and Cost Analysis
Health Care Costs
Economic Models
Therapeutics
Insurance Claim Review
Information Storage and Retrieval
Hospital Emergency Service
Inpatients
Outpatients
Observation
Databases

Keywords

  • Carcinoid syndrome
  • Diarrhea
  • Economic modeling
  • Flushing
  • Healthcare costs
  • Neuroendocrine tumors
  • Octreotide

ASJC Scopus subject areas

  • Health Policy

Cite this

Huynh, Lynn ; Totev, Todor ; Vekeman, Francis ; Neary, Maureen P. ; Duh, Mei S. ; Benson III, Al B. / Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR. In: Journal of Medical Economics. 2017 ; Vol. 20, No. 9. pp. 945-951.
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abstract = "Aims: To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor’s perspective. Materials and methods: Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79{\%} of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. Results: The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p =.03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p =.01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56{\%} of the cost reduction (p =.02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44{\%}. Limitations: The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients. Conclusions: Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.",
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Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR. / Huynh, Lynn; Totev, Todor; Vekeman, Francis; Neary, Maureen P.; Duh, Mei S.; Benson III, Al B.

In: Journal of Medical Economics, Vol. 20, No. 9, 02.09.2017, p. 945-951.

Research output: Contribution to journalArticle

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T1 - Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR

AU - Huynh, Lynn

AU - Totev, Todor

AU - Vekeman, Francis

AU - Neary, Maureen P.

AU - Duh, Mei S.

AU - Benson III, Al B

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N2 - Aims: To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor’s perspective. Materials and methods: Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. Results: The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p =.03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p =.01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p =.02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. Limitations: The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients. Conclusions: Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.

AB - Aims: To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor’s perspective. Materials and methods: Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. Results: The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p =.03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p =.01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p =.02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. Limitations: The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients. Conclusions: Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.

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