OBJECTIVES: Previous research has demonstrated the healthcare costs related to carcinoid syndrome. The objective of this study was to estimate direct medical costs and indirect costs, as a measure of productivity loss associated with carcinoid syndrome diarrhea (CSD) to a self-insured US employer.

METHODS: Adults with CS were identified in a multiemployer database based on >1 medical claim with a ICD-9/10 code for CS (259.2 or E34.0). The first CS medical claim served as the index event. Patients were continuously enrolled in the employer-sponsored plan 12 months prior (baseline) and at least 1 month after the index event. CSD patients (cases) had a medical claim of noninfectious diarrhea (ICD codes: 564.5, 787.91, K59.1, R19.7) in the baseline period and those without served as controls. Direct medical costs were compared using generalized linear models. Indirect costs were estimated by monetizing work absence data using wages derived from the bureau of labor statistics.

RESULTS: 1,352 cases and 2,691 controls met study criteria. Compared to controls, cases were significantly older (mean:60, SD:13.8 vs mean:57, SD:13.9, p<0.01), a greater proportion were females (59% vs 55%), and a lower proportion held full-time jobs (48% vs 43%). Average annual direct medical cost per patient was significantly higher for a case (mean:$105,133, SD:63,033) vs controls (mean:$54,701, SD:16,644), p<0.01. Higher inpatient use (44% vs 25%), emergency room use (55% vs 31%), and outpatient services (mean: 34 vs 23) among cases contributed to the increase. Median annual per patient absenteeism and productivity loss costs were higher for cases (146 days, $42,265) vs controls (100 days, $28,997).

CONCLUSIONS: Among CS population, direct medical costs and productivity loss are greatest among CSD patients. Reductions in healthcare expenditures and productivity loss may be achieved with appropriate treatment and management of the disease.