Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2016; 22(6): 2118-2125
Published online Feb 14, 2016. doi: 10.3748/wjg.v22.i6.2118
Healthcare and economic impact of diarrhea in patients with carcinoid syndrome
Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Maureen P Neary
Michael S Broder, Eunice Chang, Dorothy Romanus, Dasha Cherepanov, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States
Maureen P Neary, Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, United States
Author contributions: Broder MS, Chang E, Romanus D, Cherepanov D and Neary MP contributed substantially to conception, design, management of the study, interpretation of data, drafting of the manuscript, and revising the manuscript critically for significant intellectual content; Chang E conducted all statistical analyses; all authors approved the final manuscript for submission.
Supported by Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, United States.
Institutional review board statement: We conducted a retrospective cohort study using the Truven Health Analytics MarketScan® Database, a commercial health insurance claims database for employer-insured beneficiaries in the United States. The database is fully compliant with the Health Insurance Portability and Accountability Act and meets the criteria for a limited-use dataset. Since the patient and provider data included in this analysis were fully de-identified, this study was exempt from the Institutional Review Board review.
Informed consent statement: This study involved analyses of a Health Insurance Portability and Accountability Act-compliant secondary database, Truven Health Analytics MarketScan® Database, thus no informed consent was feasible or necessary.
Conflict-of-interest statement: Funding for this study was provided by Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, United States. Maureen P. Neary is an employee of Novartis Pharmaceuticals Corporation. Michael S. Broder, Eunice Chang, and Dasha Cherepanov are employees of the Partnership for Health Analytic Research, LLC (PHAR, LLC), a health services research company paid by Novartis to conduct this research; Dorothy Romanus is a former employee of PHAR, LLC.
Data sharing statement: The study statistician, Eunice Chang, conducted all statistical analysis for this study using a Health Insurance Portability and Accountability Act-compliant commercial-insurance secondary database, Truven Health Analytics MarketScan® Database.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael S Broder, MD, MSHS, President, Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States. mbroder@pharllc.com
Telephone: +1-310-8589555 Fax: +1-310-8589552
Received: August 5, 2015
Peer-review started: August 5, 2015
First decision: September 9, 2015
Revised: November 26, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: February 14, 2016
Processing time: 171 Days and 11.4 Hours
Abstract

AIM: 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).

CONCLUSION: 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.

Keywords: Carcinoid; Neuroendocrine tumor; Diarrhea; Cost; Healthcare resource utilization

Core tip: Healthcare resource utilization patterns and costs accrued by carcinoid syndrome (CS) patients with and without diarrhea have not been well described. We examined newly diagnosed CS patients using MarketScan® commercial claims data from 2003-2012 and found that non-infectious diarrhea (NID) is particularly burdensome and costly in CS patients. The adjusted proportions of patients with any and with CS-related hospitalizations were 9.7% and 6.8% higher in patients with NID than in those with no NID, respectively (P < 0.001). The NID group was also significantly more costly, with adjusted mean annual healthcare costs of $81610, compared to $51719 in the no NID group (P < 0.001).