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

Figures & data

Figure 1. Cost model.

Figure 2. Study design scheme.

Table 1. Clinical inputs from the NET 3-center chart review study for the cost model.

	Flushing or diarrhea	Diarrhea
Number of patients
With CS symptom 3 months prior to above-standard dose of octreotide LAR (%)	136 (100%)	107 (100%)
With CS symptom resolution or improvement (%)	108 (79%)	85 (79%)
Number of person days
Mean duration with CS symptom during the 12-month study period (SD)		147 (123)
Flushing	173 (133)
Diarrhea	147 (123)
Mean duration with CS symptom resolution or improvement during the  12-month study period (SD)		218 (123)
Flushing	192 (133)
Diarrhea	218 (123)

CS, Carcinoid Syndrome; SD, Standard Deviation.

Table 2. Cost inputs from claims data analysis.

	Flushing or diarrhea		Diarrhea
Cost per patient per day with CS symptom, mean (SD)
Total healthcare	$219.82	($192.11)	$234.56	($191.29)
Inpatient	$66.74	($172.99)	$76.08	($174.95)
Outpatient	$129.66	($120.90)	$134.66	($120.48)
ED	$1.80	($10.58)	$1.94	($10.58)
Pharmacy	$20.04	($31.41)	$20.54	($31.35)
Cost per patient per day without CS symptom, mean (SD)
Total healthcare	$152.11	($190.74)	$148.65	($190.14)
Inpatient	$49.46	($164.97)	$48.09	($163.02)
Outpatient	$88.42	($120.03)	$86.67	($119.75)
ED	$1.00	($10.79)	$0.96	($10.95)
Pharmacy	$13.45	($31.21)	$13.20	($31.21)

CS, Carcinoid Syndrome; ED, Emergency Department; SD, Standard Deviation.

Table 3. Clinical inputs for patients under 65 years of age from the Net 3-Center chart review study.

	Flushing or diarrhea	Diarrhea
Number of patients under 65 at index date
With CS symptom 3 months prior to above-standard dose of octreotide LAR (%)	86 (100%)	66 (100%)
With CS symptom resolution or improvement (%)	69 (80%)	53 (80%)
Number of person days for patients under 65
Mean duration with symptom during the 12-month study period (SD)		143 (121)
Flushing	163 (131)
Diarrhea	143 (121)
Mean duration with CS symptom resolution or improvement during  12-month study period (SD)		222 (121)
Flushing	202 (131)
Diarrhea	222 (121)

CS, Carcinoid Syndrome; SD, Standard Deviation.

Table 4. Cost reduction associated with CS symptom resolution or improvement: main analysis, healthcare cost.

Estimated annual mean cost per patient	Flushing or diarrhea	95% CI	p-value	Diarrhea	95% CI	p-value
Total cost
Patients with CS symptom	$80,233			$85,616
Patients with CS symptom resolution or improvement	$65,468			$66,876
Cost difference	$14,766	$1,633–$27,898	.028*	$18,740	$4,262–$33,219	.012*
Inpatient cost
Patients with CS symptom	$24,362			$27,768
Patients with CS symptom resolution or improvement	$20,471			$21,664
Cost difference	$3,891	–$6,128–$13,911	.445	$6,104	–$5,545–$17,752	.302
Outpatient cost
Patients with CS symptom	$47,325			$49,151
Patients with CS symptom resolution or improvement	$38,420			$38,684
Cost difference	$8,905	$730–$17,079	.033*	$10,467	$1,500–$19,434	.022*
ED cost
Patients with CS symptom	$658			$708
Patients with CS symptom resolution or improvement	$484			$495
Cost difference	$174	–$446–$794	.580	$213	–$518–$945	.565
Pharmacy cost
Patients with CS symptom	$7,315			$7,499
Patients with CS symptom resolution or improvement	$5,898			$5,896
Cost difference	$1,417	–$516–$3,351	.150	$1,603	–$592–$3,799	.151

95% CI, 95% Confidence Interval; CS, Carcinoid Syndrome; ED, Emergency Department; SD, Standard Deviation.

* p < .05.

Table 5. Cost reduction associated with CS symptom resolution or improvement: sensitivity analysis, direct healthcare, and indirect work loss costs.

Estimated annual mean direct and indirect cost difference per patient	Flushing or diarrhea	95% CI	p-value	Diarrhea	95% CI	p-value
Total cost difference	$15,039	$1,259–$28,819	.033*	$19,098	$4,179–$34,017	.012*
Inpatient cost difference	$3,998	–$6,166–$14,163	.439	$6,274	–$5,488–$18,036	.294
Outpatient cost difference	$9,062	$46–$18,078	.049*	$10,644	$1,120–$20,168	.029*
ED cost difference	$183	–$463–$829	.578	$223	–$525–$971	.557

95% CI, 95% Confidence Interval; ED, Emergency Department; SD, Standard Deviation.

* p < .05.