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

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.

Keywords:

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

Transparency

Declaration of funding

Funding for this research was provided by Novartis Pharmaceuticals Corporation. The study sponsor was involved in all stages of the study research and manuscript preparation, but all authors participated in the design of the study and contributed to the manuscript development.

Declaration of financial/other interests

LH, TT, FV, and MSD are employees of Analysis Group, Inc., which has received funding for this research from Novartis Pharmaceuticals Corporation. MPN is an employee of Novartis Pharmaceuticals Corporation, the sponsor of this study. ABB has previously received consultant fees from Novartis Pharmaceuticals Corporation.

Acknowledgments

The authors are grateful to Matthew H. Kulke, MD, of Dana-Farber Cancer Institute, and Jonathan R. Strosberg, MD, of Moffitt Cancer Center, for providing access to NET 3-Center study data for these analyses. The authors would also like to thank Ana Bozas, PhD, of Analysis Group, Inc., for her editorial assistance, and Michael Hellstern, of Analysis Group, Inc., for his assistance with analysis and writing.

Previous presentations

A synopsis of the current research was presented in poster format at the International Society of Gastrointestinal Oncology (ISGIO) Annual Conference (October 22–23, 2015, Arlington, VA), the Academy of Managed Care Pharmacy (AMCP) Annual Meeting (April 19–22, 2016, San Francisco, CA), and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 21st Annual International Meeting (May 21–25, 2016, Washington, DC).