Healthcare and economic impact of diarrhea in patients with carcinoid syndrome

Table 1 Baseline characteristics of patients with carcinoid syndrome, stratified by evidence of non-infectious diarrhea

	With non-infectious diarrhea	Without non-infectious diarrhea	All newly diagnosed CS patients	P value
	n = 534	n = 2288	n = 2822
Age, yr	51.3 ± 9.9	51.6 ± 10.1	51.5 ± 10.1	0.639
Charlson comorbidity index	3.7 ± 3.9	3.6 ± 3.8	3.6 ± 3.8	0.643
No. of chronic conditions	4.0 ± 2.4	3.4 ± 2.0	3.5 ± 2.1	< 0.001
Age group, yr				0.120
≤ 17	1 (0.2)	22 (1.0)	23 (0.8)
18-24	8 (1.5)	30 (1.3)	38 (1.3)
25-34	33 (6.2)	114 (5.0)	147 (5.2)
35-44	80 (15.0)	279 (12.2)	359 (12.7)
45-54	157 (29.4)	752 (32.9)	909 (32.2)
55-64	255 (47.8)	1091 (47.7)	1346 (47.7)
Sex				0.005
Female	333 (62.4)	1273 (55.6)	1606 (56.9)
Region				0.961
North Central	134 (25.1)	563 (24.6)	697 (24.7)
Northeast	86 (16.1)	358 (15.6)	444 (15.7)
South	224 (41.9)	989 (43.2)	1213 (43.0)
West	90 (16.9)	378 (16.5)	468 (16.6)

Data are expressed as absolute numbers (percentage) or mean ± SD. CS: Carcinoid syndrome.

Table 2 Annual unadjusted healthcare utilization and costs in patients with carcinoid syndrome, stratified by evidence of non-infectious diarrhea

	With non-infectious diarrhea	Without non-infectious diarrhea	P value
	n = 534	n = 2288
Overall healthcare utilization
Patients with hospitalizations	265 (49.6)	907 (39.6)	< 0.001
Average LOS among hospitalized patients (d)	11.6 ± 13.4	8.0 ± 9.2	< 0.001
Patients with ED visits	201 (37.6)	479 (20.9)	< 0.001
Outpatient physician visits	25.5 ± 18.4	18.7 ± 15.8	< 0.001
CS-related utilization1
Patients with hospitalizations	73 (13.7)	165 (7.2)	< 0.001
Average LOS among hospitalized patients (d)	7.4 ± 7.1	5.5 ± 3.6	0.029
Patients with ED visits	59 (11.0)	101 (4.4)	< 0.001
Outpatient physician visits	6.9 ± 7.8	4.1 ± 6.1	< 0.001
Healthcare costs (USD)
Total costs	82032 ± 90181.7	51621 ± 63890.8	< 0.001
Total medical costs	74654 ± 86742.3	47083 ± 61214.0	< 0.001
Total pharmacy costs	7378 ± 13949.8	4538 ± 10314.2	< 0.001

¹Claims with primary diagnosis of CS, CS-related syndrome, or carcinoid tumor progression. Data are expressed as absolute numbers (percentage) or mean ± SD. All costs were adjusted to 2012 United States dollars using the medical care components of the Consumer Price Index. CS: Carcinoid syndrome; ED: Emergency department; LOS: Length of stay.

Table 3 Multivariate analyses of annual overall and carcinoid syndrome-related hospitalization and total costs

	Any hospitalization		Any CS-related hospitalization1		Total costs
	OR (95%CI)	P value	OR (95%CI)	P value	mean (SE)	P value
Age group, yr
≤ 17 vs 55-64	0.84 (0.35-2.02)	0.702	2.38 (0.78-7.22)	0.127	$-8004 (13971.7)	0.567
18-24 vs 55-64	1.33 (0.69-2.57)	0.389	0.81 (0.24-2.70)	0.726	$-8328 (10946.6)	0.447
25-34 vs 55-64	0.93 (0.65-1.33)	0.687	0.52 (0.25-1.10)	0.087	$-10875 (5867.4)	0.064
35-44 vs 55-64	0.97 (0.76-1.23)	0.785	0.80 (0.52-1.24)	0.314	$-5474 (3993.0)	0.171
45-54 vs 55-64	0.93 (0.78-1.11)	0.412	0.85 (0.63-1.16)	0.307	$-2433 (2855.8)	0.394
Sex
Female vs Male	0.88 (0.75-1.02)	0.093	0.89 (0.68-1.17)	0.401	$-7165 (2539.7)	0.005
Region
North Central vs West	1.01 (0.79-1.28)	0.951	0.88 (0.58-1.35)	0.562	$-6623 (3954.7)	0.094
Northeast vs West	0.91 (0.69-1.19)	0.477	1.18 (0.76-1.85)	0.458	$-7458 (4393.6)	0.090
South vs West	1.02 (0.82-1.27)	0.842	0.88 (0.60-1.29)	0.521	$-11343 (3601.1)	0.002
No. of chronic conditions	1.03 (0.99-1.08)	0.107	0.98 (0.91-1.05)	0.521	$1115 (665.6)	0.094
Charlson comorbidity index	1.02 (1.00-1.04)	0.099	0.99 (0.95-1.03)	0.658	$5231 (354.5)	< 0.001
Non-infectious diarrhea
Yes vs No	1.48 (1.22-1.80)	< 0.001	2.12 (1.57-2.86)	< 0.001	$29890 (3204.5)	< 0.001

¹Claims with primary diagnosis of CS, CS-related syndrome, or carcinoid tumor progression. CS: Carcinoid syndrome.

Table 4 Adjusted multivariate analyses of annual overall and carcinoid syndrome-related hospitalization and total costs

Non-infectious diarrhea	Adjusted proportion of patients with any hospitalization1	Adjusted proportion of patients with any CS-related hospitalization12	Adjusted total cost1
	% (95%CI)	% (95%CI)	mean (95%CI)
Yes	49.4 (45.1-53.6)	13.8 (11.1-17.1)	$81610 ($75962-$87258)
No	39.7 (37.7-41.7)	7.0 (6.0-8.2)	$51719 ($49007-$54432)

¹Adjusted by age, gender, region, number of chronic conditions and the Charlson Comorbidity Index;

²Claims with primary diagnosis of CS, CS-related syndrome, or carcinoid tumor progression. CS: Carcinoid syndrome.