Advertisement

PharmacoEconomics

, Volume 36, Issue 8, pp 1005–1013 | Cite as

Costs of Cancer Care for Elderly Patients with Neuroendocrine Tumors

  • Chan ShenEmail author
  • Arvind Dasari
  • Dian Gu
  • Yiyi Chu
  • Shouhao Zhou
  • Ying Xu
  • Daniel Halperin
  • Shuangshuang Fu
  • James C. Yao
  • Ya-Chen Tina Shih
Original Research Article

Abstract

Background

The incidence and prevalence of neuroendocrine tumors (NETs) have been steadily rising. NETs can arise in various parts of the body and have distinct pathogenesis, clinical manifestations, treatment, and survival compared to other neoplasms. The magnitude of the economic burden of NETs is largely unknown. This study aimed to estimate the cost of illness for NETs among elderly patients based on a large amount of observational data.

Methods

We estimated the direct medical costs by phase of care using the Surveillance, Epidemiology, and End Results-Medicare data, including claims from January 1, 2002 through to December 31, 2012. Patients’ care was categorized into three phases: initial phase (first year after diagnosis), terminal phase (last year of life), and continuing phase (the period between). We estimated the cost of illness by calculating the difference in medical costs between NET patients and a matched sample from a non-cancer control group.

Results

Our study sample included 8409 elderly NET patients in the initial phase, 9218 patients in the continuing phase, and 7897 in the terminal phase. The mean cost of care for the initial phase was $46,462 in 2016 US dollars; mean cost of care for the terminal phase with a cancer-related death was $122,702; while the mean cost of care for the continuing phase was $10,457. The mean 5-year cost was $87,079.

Conclusions

This population-based study showed that NET patients had substantial continuing phase costs and 5-year costs. Among elderly NET patients, those with pancreas as the primary cancer site had the highest costs.

Notes

Acknowledgements

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. We thank Gary Deyter for editorial assistance.

Author contributions

All authors had unrestricted access to the final study data on request, were responsible for data interpretation, manuscript preparation, and the decision to submit for publication, and attest to the completeness and accuracy of the data and statistical analysis. All authors contributed to the planning, conduct, and reporting of the work described in the article. Chan Shen is responsible for the overall content as guarantor.

Compliance with Ethical Standards

Funding

This work was supported in part by Ipsen. The funder sponsored the purchase of SEER-Medicare data and provided funding for analytical support.

Conflict of interest

Chan Shen, Arvind Dasari, Dian Gu, Yiyi Chu, Shouhao Zhou, Ying Xu, Daniel Halperin, Shuangshuang Fu, and Ya-Chen Tina Shih declare they have no financial or non-financial conflicts of interest that are directly relevant to the content of this article. James C. Yao declares consulting fees or honorarium from Novartis and Ipsen.

Data availability statement

The data source used for this study is SEER registry data linked with Medicare claims. It is available upon request from the SEER-Medicare program.

References

  1. 1.
    Kulke MH, Shah MH, Benson AB 3rd, et al. Neuroendocrine tumors, version 1.2015. J Natl Compr Cancer Netw. 2015;13:78–108.CrossRefGoogle Scholar
  2. 2.
    Halperin DM, Yao JC, Dasari A. What’s in a name? Steady progress in staging pancreatic neuroendocrine tumors. J Clin Oncol. 2017;35:265–7.CrossRefGoogle Scholar
  3. 3.
    Scarpa A, Chang DK, Nones K, et al. Whole-genome landscape of pancreatic neuroendocrine tumours. Nature. 2017;543:65–71.CrossRefGoogle Scholar
  4. 4.
    Francis JM, Kiezun A, Ramos AH, et al. Somatic mutation of CDKN1B in small intestine neuroendocrine tumors. Nat Genet. 2013;45:1483–6.CrossRefGoogle Scholar
  5. 5.
    Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26:3063–72.CrossRefGoogle Scholar
  6. 6.
    Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3(10):1335–42.CrossRefGoogle Scholar
  7. 7.
    Kunz PL. Understanding neuroendocrine tumors—a NET gain. JAMA Oncol. 2017;3:1343–4.CrossRefGoogle Scholar
  8. 8.
    Cubanski J, et al. How much is enough? Out-of-pocket spending among Medicare beneficiaries: a chartbook. 2014. http://kff.org/report-section/how-much-is-enough-out-of-pocket-spending-among-medicare-beneficiariessection-1. Accessed 16 Apr 2018.
  9. 9.
    American Cancer Society. The costs of cancer addressing patient costs. https://www.acscan.org/sites/default/files/Costs%20of%20Cancer%20-%20Final%20Web.pdf. Accessed 1 Oct 2017.
  10. 10.
    Agency for Healthcare Research and Quality. Total expenses and percent distribution selected conditions by source of payment: United States, 2014. https://meps.ahrq.gov/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2014&Table=HCFY2014_CNDXP_D&_Debug. Accessed 1 Oct 2017.
  11. 11.
    National Cancer Institute. Surveillance, epidemiology, and end results program. https://seer.cancer.gov/. Accessed 1 Nov 2017.
  12. 12.
    Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40:Iv-3-18.PubMedGoogle Scholar
  13. 13.
    National Cancer Institute. Cancer prevalence and cost of care projections. https://costprojections.cancer.gov/. Accessed 1 Oct 2017.
  14. 14.
    Yabroff KR, Lamont EB, Mariotto A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100:630–41.CrossRefGoogle Scholar
  15. 15.
    Bureau of Labor Statistics. http://www.bls.gov/data/. Accessed 1 Oct 2017.
  16. 16.
    Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117–28.CrossRefGoogle Scholar
  17. 17.
    Halperin DM, Shen C, Dasari A, et al. Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study. Lancet Oncol. 2017;18:525–34.CrossRefGoogle Scholar
  18. 18.
    Rinke A, Muller HH, Schade-Brittinger C, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009;27:4656–63.CrossRefGoogle Scholar
  19. 19.
    Raymond E, Dahan L, Raoul JL, et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med. 2011;364:501–13.CrossRefGoogle Scholar
  20. 20.
    Yao JC, Shah MH, Ito T, et al. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med. 2011;364:514–23.CrossRefGoogle Scholar
  21. 21.
    Gaba RC, Mendoza-Elias N, Morrison JD, Valeshabad AK, Lipnik AJ. Decision making for selection of transarterial locoregional therapy of metastatic neuroendocrine tumors. Semin Intervent Radiol. 2017;34:101–8.CrossRefGoogle Scholar
  22. 22.
    Hallet J, Law CHL, Cheung M, et al. Patterns and drivers of costs for neuroendocrine tumor care: a comparative population-based analysis. Ann Surg Oncol. 2017;24(11):3312–23.CrossRefGoogle Scholar
  23. 23.
    Lang K, Lines LM, Lee DW, Korn JR, Earle CC, Menzin J. Lifetime and treatment-phase costs associated with colorectal cancer: evidence from SEER-Medicare data. Clin Gastroenterol Hepatol. 2009;7:198–204.CrossRefGoogle Scholar
  24. 24.
    Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the US: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev. 2011;20:2006–14.CrossRefGoogle Scholar
  25. 25.
    Allaire BT, Ekwueme DU, Poehler D, et al. Breast cancer treatment costs in younger, privately insured women. Breast Cancer Res Treat. 2017;164:429–36.CrossRefGoogle Scholar
  26. 26.
    Shen C, Chu Y, Halperin DM, et al. Carcinoid syndrome and costs of care during the first year after diagnosis of neuroendocrine tumors among elderly patients. Oncologist. 2017;22(12):1451–62.CrossRefGoogle Scholar
  27. 27.
    Bradley CJ, Yabroff KR, Dahman B, Feuer EJ, Mariotto A, Brown ML. Productivity costs of cancer mortality in the United States: 2000–2020. J Natl Cancer Inst. 2008;100:1763–70.CrossRefGoogle Scholar
  28. 28.
    Yabroff KR, Guy GP, Ekwueme DU, et al. Annual patient time costs associated with medical care among cancer survivors in the United States. Med Care. 2014;52:594–601.CrossRefGoogle Scholar
  29. 29.
    Zheng Z, Yabroff KR, Guy GP, et al. Annual medical expenditure and productivity loss among colorectal, female breast, and prostate cancer survivors in the United States. J Natl Cancer Inst. 2015;108(5):djv382.CrossRefGoogle Scholar
  30. 30.
    Zafar SY. Financial toxicity of cancer care: it’s time to intervene. J Natl Cancer Inst. 2016;108(5):djv370.CrossRefGoogle Scholar
  31. 31.
    Vinik AI, Wolin EM, Liyanage N, Gomez-Panzani E, Fisher GA. Evaluation of lanreotide depot/autogel efficacy and safety as a carcinoid syndrome treatment (ELECT): a randomized, double-blind, placebo-controlled trial. Endocr Pract. 2016;22:1068–80.CrossRefGoogle Scholar
  32. 32.
    Strosberg J, El-Haddad G, Wolin E, et al. Phase 3 trial of (177)Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376:125–35.CrossRefGoogle Scholar
  33. 33.
    Yao JC, Fazio N, Singh S, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. Lancet. 2016;387:968–77.CrossRefGoogle Scholar
  34. 34.
    Kulke MH, Horsch D, Caplin ME, et al. Telotristat ethyl, a tryptophan hydroxylase inhibitor for the treatment of carcinoid syndrome. J Clin Oncol. 2017;35:14–23.CrossRefGoogle Scholar
  35. 35.
    Caplin ME, Pavel M, Cwikla JB, et al. Lanreotide in metastatic enteropancreatic neuroendocrine tumors. N Engl J Med. 2014;371:224–33.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Chan Shen
    • 1
    • 2
    Email author
  • Arvind Dasari
    • 3
  • Dian Gu
    • 1
  • Yiyi Chu
    • 1
  • Shouhao Zhou
    • 2
  • Ying Xu
    • 1
  • Daniel Halperin
    • 3
  • Shuangshuang Fu
    • 4
  • James C. Yao
    • 3
  • Ya-Chen Tina Shih
    • 1
  1. 1.Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Epidemiology, Human Genetics, and Environmental ScienceThe University of Texas Health Science Center in HoustonHoustonUSA

Personalised recommendations