title: Healthcare and economic impact of diarrhea in patients with carcinoid syndrome.
abstract: OBJECTIVE
  To examine healthcare resource utilization patterns and costs accrued by carcinoid syndrome (CS) patients with and without diarrhea.
  
  
  METHODS
  We conducted a retrospective cohort study using MarketScan® data from 1/1/2002-12/31/2012. Newly diagnosed CS patients had 1 medical claim for CS (ICD-9-CM code 259.2) plus either ≥ 1 additional claim for CS or for carcinoid tumors (ICD-9-CM 209.x), and had no evidence of CS for 1 year prior to index CS diagnosis, in commercially-insured patients < 65 years old. Patients were required to have continuous enrollment one year prior and after index date (first claim with CS diagnosis in the ID period). We identified patients with evidence of non-infectious diarrhea (ICD-9-CM codes 564.5 and 787.91) within one year from the index date. Overall and CS-related healthcare resource utilization and costs were compared between patients with and without non-infectious diarrhea during the one year period after the index date.
  
  
  RESULTS
  There were 2822 newly diagnosed CS patients; 534 (18.9%) had evidence of non-infectious diarrhea. Compared to patients without non-infectious diarrhea, non-infectious diarrhea patients more commonly had at ≥ 1 CS-related hospitalization (13.7% vs 7.2%), ≥ 1 CS-related ED visit (11.0% vs 4.4%), and CS-related office visits in one year (6.9 vs 4.1; all P < 0.001). After adjusting for demographics, region, number of chronic conditions and the Charlson Comorbidity Index, the proportions of patients with any and with CS-related hospitalizations were 9.7% and 6.8% higher, respectively, among non-infectious diarrhea patients compared to those with without non-infectious diarrhea (P < 0.001). Unadjusted costs were significantly higher among non-infectious diarrhea patients vs those without non-infectious diarrhea. The non-infectious diarrhea group was also more costly, with adjusted mean annual costs of $81610, compared to $51719 in the group without non-infectious diarrhea (P < 0.001).
  
  
  CONCLUSIONS
  Diarrhea is burdensome and costly in CS patients. Reduction of CS-related healthcare expenditures may be achievable through preventive treatment and appropriate management of diarrhea in CS.
authors.affiliation: Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
authors.affiliation: Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors.forename: Eunice
authors.initials: E
authors.lastname: Chang
authors.affiliation: Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Romanus
authors.affiliation: Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors.forename: Dasha
authors.initials: D
authors.lastname: Cherepanov
authors.affiliation: Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Neary
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: Carcinoid; Cost; Diarrhea; Healthcare resource utilization; Neuroendocrine tumor