Work productivity burden and indirect costs associated with carcinoid syndrome diarrhea

ABSTRACT

Objectives: We estimated the indirect costs of work productivity burden from carcinoid syndrome diarrhea (CSD) among employed, insured adults in the United States.

Methods: Retrospective cohort study of patients ≥18 years old with CS who did and did not have CSD (2014–2016). Eligible patients had continuous health plan enrollment for ≥12 months prior to their first CS claim and for ≥30 days after. Univariate analyses of clinical and work productivity outcomes and indirect costs were conducted. Multivariate analyses examined associations of CSD with work productivity measures, controlling for baseline characteristics.

Results: A total of 1,880 patients with CS were eligible, including 577 with CSD and 1,303 with CS only. Baseline characteristics were generally similar. Patients with CSD missed half of eligible workdays (median 56%, 146/260); those with CS-only missed one-third (38%, 100/260). Work productivity was lower and the associated costs were higher in the presence of CSD. Patients with CSD had more absenteeism, short-term disability, and lost workdays which translated into incremental mean costs of $16,679 greater than those with CS only.

Conclusion: Indirect costs related to work productivity losses among adults with CSD are significant, which further add to the burden of CSD to society.

KEYWORDS:

• Carcinoid syndrome
• carcinoid syndrome diarrhea
• neuroendocrine tumors
• work productivity
• indirect costs

Article Highlights

• The indirect costs of carcinoid syndrome diarrhea (CSD) have not been well characterized in the recent literature; we investigated the work productivity burden of CSD in a population of actively employed insured adults.

• Patients with CSD missed approximately half of eligible workdays, compared to one-third missed days among patients with CS and no diarrhea.

• Work productivity was lower and the associated costs of lost productivity were higher in the presence of CSD, as patients with CSD had more absenteeism hours, short-term disability days, and more lost workdays translating into incremental mean annual costs of lost productivity of $16,679 greater than those with CS only.

• Short-term annual disability payments were on average $13,773 (median, $2,375) for patients with CSD and $9,707 (median $4,928) for those with CS only.

• Adults with CS miss a substantial proportion of eligible work hours and workdays, particularly those with CSD, which is associated with notable indirect costs.

• Timely identification, differential diagnosis and management of CSD in patients with CS may reduce the burden on work productivity and costs among working age adults.

Author contribution

All authors contributed to the study conception and design; VJN, SD acquired the data; SD analyzed the data; all authors contributed to the interpretation of the data; JF drafted the manuscript; all authors contributed to the critical review and revision of the manuscript, and to approval of the final draft for submission.

Declaration of interest

A Dasari received consulting honoraria for participation in this study from Lexicon Pharmaceuticals, Inc. DM Halperin received consulting honoraria for participation in this study from Lexicon Pharmaceuticals, Inc. S Dharba is an employee of DataWave Solutions which received funding for this research from Lexicon Pharmaceuticals, Inc. VN Joish and K Balaji are employees of Lexicon Pharmaceuticals, Inc. and R Perez-Olle was an employee of Lexicon Pharmaceuticals, Inc. during the conduct of the study and development of the manuscript; they may own common stock or may have been granted stock options or other equity incentive awards. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

A reviewer on this manuscript has disclosed the following; Lexicon advisory board member, Entrinsic Health, Inc supported clinical research, Novartis supported clinical research, Oncotelic, Inc supported clinical research and AbbVie supported clinical research. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research was sponsored by Lexicon Pharmaceuticals, Inc. All authors participated in the design, conduct, analysis and interpretation of findings.  Drs. Dasari and Halperin were reimbursed for their consulting hours funded by the sponsor. Medical writing support was provided by Jeff Frimpter, MPH, funded by Lexicon Pharmaceuticals, Inc.