Direct costs of carcinoid syndrome diarrhea among adults in the United States

Table 1 Baseline demographic and clinical characteristics

	CSD (n = 1352)	CS only (n = 2691)	P value
Age (yr)
Mean (SD)	60.3 (13.8)	57.3 (13.9)	< 0.001
Sex, n (%)
Female	799 (59)	1477 (55)	0.011
Male	553 (41)	1214 (45)
Primary tumor site, n (%)
Malignant carcinoid tumor of unspecified site	295 (22)	331 (12)	< 0.0001
Malignant carcinoid tumors of the small intestine	303 (22)	328 (12)	< 0.0001
Malignant carcinoid tumors of the appendix, large intestine, rectum	110 (8)	137 (5)	< 0.0001
Malignant carcinoid tumors of other sites	429 (32)	523 (19)	< 0.0001
Malignant poorly differentiated neuroendocrine tumors	168 (12)	216 (8)	< 0.0001
Other malignant neuroendocrine tumors	69 (5)	60 (2)	< 0.0001
Malignant neoplasm of endocrine pancreas	28 (2)	31 (1)	0.022
Region, n (%)
South	535 (40)	1122 (42)	0.059
North Central	331 (24)	574 (21)
Northeast	268 (20)	600 (22)
West	205 (15)	367 (14)
Unknown	13 (1)	28 (1)
Metropolitan statistical area, n (%)
Urban	1145 (85)	2364 (88)	0.005
Rural	206 (15)	327 (12)
Employment status
Active, full-time	577 (43)	1303 (48)	–
Active, part-time or seasonal	3 (0.2)	20 (1)
Early retiree	465 (34)	717 (27)
Other/unknown	307 (23)	651 (24)
Health insurance plan type, n (%)
PPO	794 (59)	1654 (61)	0.001
Comprehensive	200 (15)	286 (11)
CDHP/HDHP	143 (11)	305 (11)
HMO	123 (9)	195 (7)
POS/POS with capitation	71 (5)	176 (7)
EPO	7 (1)	36 (1)
Missing/unknown	14 (1)	39 (1)
Charlson comorbidity index, mean (SD)comorbidities	1.6 (3.5)	1.0 (2.9)	< 0.0001
Nausea/vomiting	411 (30)	294 (11)	< 0.0001
Flushing	70 (5)	46 (2)	< 0.0001
Asthma	147 (11)	228 (8)	0.013
Dyspnea/wheezing	364 (27)	546 (20)	< 0.0001
Cardiac palpitations	105 (8)	160 (6)	0.027
Hypotension	47 (3)	42 (2)	< 0.0001
Asthenia/fatigue	424 (31)	614 (23)	< 0.0001
Dizziness	184 (14)	248 (9)	< 0.0001
Intestinal complication	96 (7)	94 (3)	< 0.0001
Carcinoid heart disease	231 (17)	327 (12)	< 0.0001
Vascular condition	581 (43)	899 (33)	< 0.0001
Metastasis/secondary neoplasm	(9)	428 (16)	< 0.0001
Baseline treatment, n (%)
Immediate release somatostatin analog	36 (3)	25 (1)	< 0.0001
Long-acting somatostatin analog, octreotide	427 (32)	429 (16)	< 0.0001
Long-acting somatostatin analog, lanreotide	18 (1)	17 (1)	0.024
Chemotherapy	84 (6)	104 (4)	0.001
Peptide receptor radionuclide therapy	232 (17)	277 (10)	< 0.0001
Ablative liver therapy	3 (0.2)	20 (1)	0.038
Targeted therapy	45 (3)	46 (2)	0.001

SD: Standard deviation; IQR: Interquartile range; PPO: Preferred provider organization; CDHP: Consumer-directed health plan; HDHP: High-deductible health plan; POS: Point-of-service; EPO: Exclusive provider organization; CS: Carcinoid syndrome; CSD: CS diarrhea.

Table 2 Healthcare resource use adjusted for baseline demographic and clinical characteristics

	CSD (n = 1352), mean (SD)	CS only (n = 2691), mean (SD)	P value1
Hospital admissions	0.8 (1.8)	0.4 (1.2)	< 0.0001
Length of hospital stay	5.3 (17.0)	2.3 (11.7)	< 0.0001
Physician office visits	16.3 (9.8)	12.0 (9.2)	< 0.0001
Emergency room visits	1.3 (3.1)	0.6 (1.6)	< 0.0001
Outpatient services	34.2 (28.4)	23.1 (23.2)	< 0.0001
Prescription claims	41.5 (33.1)	30.5 (27.6)	< 0.0001

¹Significance of estimates from the generalized linear model with Poisson distribution and log link. Covariates included age (continuous), prior specific outcome, charlson comorbidity index, sex, health insurance plan type, region, and metropolitan statistical area. CS: Carcinoid syndrome; CSD: CS diarrhea.

Table 3 Healthcare costs

	CSD (n = 1352), mean (median)	CS only (n = 2691), mean (median)	P value1
Overall expenditures	$105153 ($63033)	$54701 ($16644)	< 0.0001
Hospitalization	$26361 ($0)	$13247 ($0)	0.11
Physician office	$2075 ($1653)	$1452 ($1060)	< 0.0001
Emergency room	$2666 ($192)	$994 ($0)	< 0.0001
Outpatient services	$59258 ($31218)	$32014 ($7735)	< 0.0001
Prescriptions	$14792 ($3401)	$6994 ($1361)	< 0.0001

¹Significance of estimates from the generalized linear model with gamma distribution and log link. Covariates included age (continuous), prior specific cost for that category, charlson comorbidity index, sex, health insurance plan type, region, and metropolitan statistical area. CS: Carcinoid syndrome; CSD: CS diarrhea.