title: Clinical characteristics, treatment patterns, and economic burden in patients treated for neuroendocrine tumors in the United States: a retrospective cohort study.
abstract: OBJECTIVE
  To assess patient characteristics, treatment patterns, and healthcare resource utilization (HRU)/costs of individuals treated for neuroendocrine tumors (NETs) in the US.
  
  
  METHODS
  Using a US administrative claims database, this study identified commercially-insured adults newly diagnosed with carcinoid tumors (ICD-9-CM: 209.xx) or pancreatic islet cell tumors (ICD-9-CM: 157.4 and 211.7) between July 1, 2007 and December 31, 2010 (date of first observed diagnosis denoted the index date). Patients were required to have 6-month pre-index and 12-month post-index continuous enrollment, and treatment by medical and/or surgical therapy during the 12-month follow-up. Descriptive analyses were performed to assess demographic/clinical characteristics, treatment patterns, HRU, and total healthcare cost in two mutually exclusive cohorts, medical and surgical therapy.
  
  
  RESULTS
  This study included 625 individuals with NETs treated with medical therapy (mean age: 54.2 years; 53.4% female) and 831 treated with surgical therapy (mean age: 51.3 years; 52.6% female). Among the medical therapy cohort, carcinoid syndrome (72.3%), liver metastasis (62.6%), and diarrhea (28.3%) were the most prevalent symptoms/co-morbidities in the 12-month post-index period; 92.3% received octreotide long-acting release, 35.8% had hospitalization admissions, and 37.9% had emergency room visits. The total monthly healthcare cost increased from $5629.7 in the pre-index period to $9093.3 in the post-index period. Among the surgical therapy cohort, carcinoid syndrome (40.3%), nausea and/or vomiting (28.5%), and liver metastasis (24.3%) were the most prevalent symptoms/comorbidities in the 12-month post-index period; 31.4% received surgical resection or removal of large intestine, 94.7% had hospitalization admissions, and 45.5% had emergency room visits. The total monthly healthcare cost increased from $2547.9 in the pre-index period to $8810.4 in the post-index period.
  
  
  CONCLUSIONS
  Substantial clinical and economic burden exists among individuals with NET treated with medical or surgical therapies. Future research should investigate this treated sub-population considering a longer follow-up due to slow disease progression.
authors.affiliation: Evidera , Lexington, MA , USA.
authors.forename: Chien-Chia
authors.initials: CC
authors.lastname: Chuang
authors.forename: Sharvari
authors.initials: S
authors.lastname: Bhurke
authors.forename: Shin-Yin
authors.initials: SY
authors.lastname: Chen
authors.forename: Siham
authors.initials: S
authors.lastname: Brulais
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gabriel
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics; D003131:Combined Modality Therapy / Q000191:economics; D015897:Comorbidity; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Healthcare costs; Healthcare resource utilization; Neuroendocrine tumor; Treatment patterns