First-line systemic treatment adherence, healthcare resource utilization, and costs in patients with gastrointestinal neuroendocrine tumors (GI NETs) in the USA

Figures & data

Figure 1. Patient identification. There were 2,900 and 2,453 GI NET patients who also had a claim for pharmacologic treatment in the MarketScan and PharMetrics databases, respectively. After excluding patients who had treatment during a 6-month pre-index period (and, therefore, were considered to be continuing, rather than initiating, treatment); received treatment before receiving a diagnosis of GI NET; were <18 years old; or were not continuously enrolled in the 6-month pre-index period, there remained 2,258 newly-treated GI NET patients who were included in the study. ^aSomatostatin analogs (SSA), targeted therapy, cytotoxic chemotherapy, or interferon; ^b324 (34.8%) within 3 months, and 516 (55.4%) within 6 months; ^c249 (35.0%) within 3 months, and 380 (53.4%) within 6 months.

Table 1. First-line treatment in patients with 1 or 2 years post-index enrollment.

	≥1-year post-index enrollment	≥2-years post-index enrollment
No. of patients	1,322	685
First-line treatment, n (%)
Somatostatin analogs (SSA)	847 (64.1)	452 (66.0)
Cytotoxic Chemo (CC)	397 (30.0)	189 (27.6)
Targeted Therapy (TT)	35 (2.6)	20 (2.9)
SSA + CC	24 (1.8)	16 (2.3)
SSA + TT	14 (1.1)	6 (0.9)
TT + CC	1 (0.1)	0 (0)
Interferon (IF)	2 (0.2)	1 (0.1)
SSA + IF	1 (0.1)	1 (0.1)
SSA + TT + CC	1 (0.1)	0 (0)
Duration of first-line treatment  during follow-up, days,  mean (SD) [median]	522 (428.6) [431]	688 (510.8) [725]

Table 2. Demographic characteristics in patients with 1-year post-index continuous enrollment.

	Somatostatin Analogs (SSA)	Cytotoxic Chemo (CC)	Targeted Therapy (TT)	SSA + CC	SSA + TT	TT + CC	Interferon (IF)	SSA + IF	SSA + TT + CC	All
n (%)	847 (64.1)	397 (30.0)	35 (2.6)	24 (1.8)	14 (1.1)	1 (0.1)	2 (0.2)	1 (0.1)	1 (0.1)	1,322 (100.0)
Age, years, mean (SD)	55.8 (8.9)	54.0 (9.4)	55.5 (8.1)	51.2 (9.9)	53.4 (9.7)	62.0 (0)	58.5 (3.5)	58.0 (0)	55.0 (0)	55.1 (9.1)
18–24, n (%)	5 (0.6)	1 (0.3)	0 (0)	1 (4.2)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	7 (0.5)
25–34, n (%)	11 (1.3)	13 (3.3)	0 (0)	1 (4.2)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	25 (1.9)
35–44, n (%)	73 (8.6)	51 (12.8)	4 (11.4)	4 (16.7)	1 (7.1)	0 (0)	0 (0)	0 (0)	0 (0)	133 (10.1)
45–54, n (%)	247 (29.2)	122 (30.7)	8 (22.9)	8 (33.3)	7 (50.0)	0 (0)	0 (0)	0 (0)	0 (0)	392 (29.7)
55–64, n (%)	433 (51.1)	182 (45.8)	20 (57.1)	10 (41.7)	5 (35.7)	1 (100.0)	2 (100.0)	1 (100.0)	1 (100.0)	655 (49.5)
65+, n (%)	78 (9.2)	28 (7.1)	3 (8.6)	0 (0)	1 (7.1)	0 (0)	0 (0)	0 (0)	0 (0)	110 (8.3)
Female, n (%)	427 (50.4)	187 (47.1)	17 (48.6)	14 (58.3)	7 (50.0)	1 (100.0)	1 (50.0)	0 (0.0)	0 (0.0)	654 (49.5)
Region, n (%)
Midwest	185 (21.8)	95 (23.9)	9 (25.7)	5 (20.8)	3 (21.4)	0 (0)	1 (50.0)	0 (0)	0 (0)	298 (22.5)
Northeast	164 (19.4)	84 (21.2)	5 (14.3)	5 (20.8)	4 (28.6)	1 (100.0)	0 (0)	0 (0)	0 (0)	263 (19.9)
South	359 (42.4)	170 (42.8)	17 (48.6)	9 (37.5)	6 (42.9)	0 (0)	1 (50.0)	0 (0)	1 (100.0)	563 (42.6)
West	139 (16.4)	48 (12.1)	4 (11.4)	5 (20.8)	1 (7.1)	0 (0)	0 (0)	1 (100.0)	0 (0)	198 (15.0)
Medication possession ratio among  patients with 2+ fills^a,^b, n (mean) [SD]	791 (0.817) [0.221]	367 (0.817) [0.242]	31 (0.760) [0.234]	n/a	n/a	n/a	2 (0.882) [0.167]	n/a	n/a	n/a
Proportion of days covered in first year  since index date^a, mean (SD)	0.669 (0.331)	0.466 (0.236)	0.505 (0.328)	n/a	n/a	n/a	0.452 (0.449)	n/a	n/a	n/a

^aFor first-line monotherapy only.

^bNumber of patients with 2 or more fills of first-line monotherapy.

Table 3. All-cause healthcare resource utilization in patients with 1-year post-index continuous enrollment.

	Somatostatin Analogs (SSA)	Cytotoxic Chemo (CC)	Targeted Therapy (TT)
n (%)	847 (64.1)	397 (30.0)	35 (2.6)
No. of office visits, n (%)	20.5 (13.5)	30.5 (19.8)	17.7 (12.5)
No. of ED visits, n (%)	0.58 (1.48)	0.57 (1.37)	0.83 (1.54)
0	587 (69.3)	274 (69.0)	21 (60.0)
1	163 (19.2)	78 (19.6)	7 (20.0)
2	48 (5.7)	24 (6.0)	4 (11.4)
3+	49 (5.8)	21 (5.3)	3 (8.6)
No. of inpatient hospitalizations, n (%)	0.59 (1.03)	0.89 (1.45)	1.23 (1.93)
0	545 (64.3)	220 (55.4)	18 (51.4)
1	191 (22.6)	102 (25.7)	9 (25.7)
2	59 (7.0)	32 (8.1)	2 (5.7)
3+	52 (6.1)	43 (10.8)	6 (17.1)
No. of patients with ≥1 hospitalization,  n (%)	302 (35.7)	177 (44.6)	17 (48.6)
Days of stay among patients with  hospitalizations, mean (SD)	9.3 (16.5)	11.8 (15.9)	19.0 (22.7)

Table 4. All-cause healthcare costs in patients with 1-year post-index continuous enrollment.

	Somatostatin Analogs (SSA)	Cytotoxic Chemo (CC)	Targeted Therapy (TT)
n (%)	847 (64.1)	397 (30.0)	35 (2.6)
All-cause healthcare costs, mean (SD)
Total costs	$99,691 (82,423)	$134,912 (116,078)	$158,397 (82,878)
Total outpatient pharmacy costs	$7,344 (14,873)	$9,646 (20,253)	$68,867 (45,387)
Total medical (non-outpatient pharmacy) costs	$92,347 (80,275)	$125,266 (115,188)	$89,530 (83,013)
Total inpatient hospitalizations costs	$16,499 (35,942)	$24,732 (51,410)	$26,603 (57,321)
Total ED visits costs	$686 (2,415)	$649 (3,669)	$621 (1,008)
Other outpatient medical costs	$75,162 (63,930)	$99,885 (88,611)	$62,306 (60,770)
Total office visit costs	$25,973 (30,698)	$35,920 (45,220)	$4,807 (7,632)
Medical cancer-related costs	$58,301 (61,910)	$73,454 (73,170)	$38,232 (43,229)
Medical non-cancer-related costs	$34,046 (44,730)	$51,812 (76,330)	$51,299 (71,032)

Table 5. Annual healthcare resource utilization and cost in year 1 and 2 among patients with 2-years post-index continuous enrollment.

	Somatostatin Analogs (SSA)	Cytotoxic Chemo (CC)	Targeted Therapy (TT)
n (%)	452 (66.0)	189 (27.6)	20 (2.9)
No. of office visits, mean (SD)
Y1	19.6 (13.0)	30.4 (19.5)	17.0 (12.7)
Y2	18.0 (13.4)	15.4 (13.0)	12.1 (8.2)
No. of inpatient hospitalizations, mean (SD)
Y1	0.57 (1.00)	0.65 (1.19)	0.45 (0.69)
Y2	0.39 (0.88)	0.43 (1.04)	0.85 (2.18)
Total costs, mean (SD)
Y1	$95,999 (71,400)	$117,670 (104,528)	$147,169 (75,379)
Y2	$87,928 (85,028)	$58,726 (94,490)	$110,921 (77,672)