Abstract
PurposeTo report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours.MethodsA cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire.ResultsTwenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22; P = 0.028) and ED costs (€161.25 vs €14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS).ConclusionThis study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.
Highlights
Neuroendocrine tumours (NETs) are a diverse group of tumours derived from neural ridge cells, endocrine glands, islets or cells, which share the propensity to secrete active hormones such as serotonin [1]
The primary objective was to determine the use of healthcare resources and their associated costs and the effects on capacity to work in patients with controlled and uncontrolled Carcinoid syndrome (CS) and grade 1–2 metastatic NETs receiving somatostatin analogues (SSAs)
Effects on capacity to work were based on the responses to the Work Productivity and Activity Impairment General Health (WPAI-GH) questionnaire [24], which assesses the occupational impact of a disease over the past 7 days
Summary
Neuroendocrine tumours (NETs) are a diverse group of tumours derived from neural ridge cells, endocrine glands, islets or cells, which share the propensity to secrete active hormones such as serotonin [1] They are relatively rare, with an incidence of around 6.98/100,000/year and accounting for 0.5% of all newly diagnosed malignancies [2], their incidence has markedly increased over the past 15 years [3, 4]. While this increased incidence may be due to improved detection [3], diagnosis remains complex This is in part due to the nonspecific and often late-presenting symptoms: many patients attend several specialists and undergo multiple investigations before a definitive diagnosis is made [1]. Following a trigger such as general anaesthetic, a severe and life-threatening carcinoid crisis may occur, with massive uncontrolled release of amines, resulting in arrhythmias and cardiovascular instability [11]
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