Carcinoid syndrome describes the hormonal effects of carcinoid tumors, including the secretion of serotonin into the systemic circulation causing episodic diarrhea. Despite the frequent occurrence of this symptom, the healthcare costs and utilization associated with non-infectious diarrhea has not been elucidated. The researchers at PHAR and Novartis Pharmaceuticals Corporation presented their study on the economic impact of Non-Infectious Diarrhea in Patients with Carcinoid Syndrome at the 2015 North American Neuroendocrine Tumor Society’s Annual Symposium. They found that non-infectious diarrhea in newly-diagnosed carcinoid syndrome patients is associated with a significantly increased annual healthcare utilization and an additional $30,000 in total annual healthcare costs. The poster can be viewed here.

The Academy of Managed Care Pharmacy awarded its Silver Medal to a study conducted by PHAR and researchers from Novartis Pharmaceuticals Corporation. This retrospective claims analysis found that the per patient healthcare cost of Cushing’s disease care was more than double the cost for diabetes care and quadruple the cost for population-based controls. The study was presented at the AMCP Nexus Conference in Boston, MA. The poster can be viewed here.

A study completed by PHAR and researchers at bioTheranostics Inc found that use of bioTheranostics’ CancerTYPE ID® molecular test is a cost-effective approach to standardizing diagnostic methods for patients with metastatic tumors of uncertain origin while improving patient care. The study was the first of its kind to examine the implications of molecular classification in standardizing the diagnostic process for metastatic cancer. It was designed to estimate the clinical and economic tradeoffs of using CancerTYPE ID to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the gene assay could be used to standardize the diagnostic process and costs for clinicians, payers, and patients. It was recently published in the Journal of Medical Economics and can be read here. The full press release can be accessed here.

PHAR announced that results from the first study to assess the clinical utility of the DCIS Score Assay in management of DCIS will be presented at American Society of Clinical Oncology (ASCO) Annual Meeting. Clinicians and breast cancer patients must decide among multiple treatment options including breast conserving surgery, mastectomy, partial or whole breast radiation, and hormonal manipulation. Treatment recommendations are usually made using clinicopathologic factors to estimate average local recurrence risk for similar patients. The validated Oncotype® DX 12-gene assay for DCIS gives additional, independent, individual estimates of 10-year risk In association with 10 cancer centers throughout the United States, PHAR conducted a prospective observation study on the impact of the DCIS Score result on radiation treatment recommendations for patients with DCIS. The study results will be presented at ASCO’s 50th Annual Meeting in Chicago, IL, and can be viewed here.

PHAR partnered with researchers at Genentech Inc. to study the relationship between the Healthcare Effectiveness Data and Information Set (HEDIS) and Asthma-Related Outcomes. Patients with low asthma medication ratio (AMR< 0.5) had worse asthma control by multiple measures including hospitalization/ED visits, OCS use, and SABA use. The number of asthma-related office visits was also slightly higher for low AMR patients. The findings support the use of AMR as a quality of care measurement for patients with persistent asthma. The Academy of Managed Care Pharmacy awarded this study a silver medal at their annual meeting. The poster presented at the AMCP Annual Meeting can be viewed here.

Dr. Gordon Sun of PHAR, along with researchers from the University of Michigan and VA Center for Clinical Management Research compared postoperative technical, quality-of-life, and cost outcomes following either robotic or open thyroidectomy for thyroid nodules and cancer. They  examined relevant controlled trials, comparative effectiveness studies, and cohort studies for eligible publications to calculate the pooled relative risk for key postoperative complications, mean differences for operative time, and standardized mean differences for length of stay using random effects models.  They found that the robotic approaches may introduce the risk of new complications and require longer operative times. The study can be read here.

Despite the availability of numerous antiepileptic drugs, some epilepsies remain resistant to treatment. We compared utilization and costs in patients with uncontrolled epilepsy to those with stable epilepsy using commercial insurance claims data.  We found patients with uncontrolled epilepsy use more services and incur higher costs compared with those with stable epilepsy. Epilepsy-related costs accounted for <50% of the total costs, suggesting that comorbid conditions and/or under identification of utilization may substantially contribute to costs. This study was published in Epilepsy & Behavior and can be read here.

Given the small magnitude of benefit with adjuvant therapy in stage II colon cancer, chemotherapy is often selected for patients based on their physicians’ subjective assessment of clinical factors. To help guide oncologists’ adjuvant treatment recommendations for standard risk patients where other existing markers are not informative, the 12-gene colon cancer Oncotype DX® Recurrence Score® Assay was developed. The investigators at PHAR in collaboration with Genomic Health studied the effects of the assays by conducting physician surveys. U.S. medical oncologists who ordered the assay for ≥3 stage II colon cancer patients were asked to complete a web-based survey regarding their most recent such patient. They found that the use of the Oncotype DX assay is associated with an overall change of nearly one in three treatment recommendations for stage II colon cancer patients, and that it may lead to more appropriate use of adjuvant treatment. The study can be read here.

There are no clinical guidelines on best practices for the use of bronchoscopy and esophagoscopy in diagnosing head and neck cancer.  Dr. Gordon Sun of PHAR partnered with investigators from the University of Michigan and the University of Pennsylvania to examine variation in the use of bronchoscopy and esophagoscopy across hospitals in Michigan through a retrospective cohort study of the Michigan State Ambulatory Surgery Database.  The authors found that patients with head and neck cancer who are undergoing diagnostic laryngoscopy are much more likely to undergo concurrent bronchoscopy and esophagoscopy at low- and medium-volume hospitals than at high-volume hospitals.  The publication can be viewed here.

Experts from Eisai presented findings of a PHAR/Eisai study on chemotherapy-induced nausea and vomiting (CINV) medication at the MASCC/ISOO International Symposium on Supportive Care in Cancer, held in Berlin, Germany. The investigators compared the cost and occurrence of CINV between patients who were only prescribed palonosetron and patients who were prescribed the generic alternative in combination with other oral medication. The study found that patients treated with palonosetron alone had a significantly lower risk of CINV, and lower CINV-related charges, than patients treated with generic alternatives. The poster can be viewed here