, 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



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.


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.


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.


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.



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


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.


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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

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