Background: Understanding the economic implications of changes in treatment among patients with NET will be important as treatment sequencing continues to evolve. This study describes treatment characteristics and healthcare costs prior to and following treatment change from somatostatin analog (SSA) monotherapy to another therapy among a privately-insured NET patient population in the U.S. Methods: Patients with newly diagnosed NET and treated with SSA monotherapy were extracted from IBM MarketScan claims databases in 1/1/2014-3/31/2019. NET treatment change was captured ≥30 days after SSA start date (earliest new treatment = index date). Healthcare costs (reimbursed amount in 2019 dollars) were reported for 1, 3, and 6 months pre- and post-index intervals. Results: A total of 1,122 NET patients with SSA monotherapy were identified; 305 had further treatment changes (mean age: 58 years; female: 52%; metastatic disease at NET diagnosis: 49%). The majority of patients started on octreotide (81%) vs lanreotide (19%). Common treatment changes included alternate SSA (38%), targeted therapy (everolimus or sunitinib) (30%) or chemotherapy (23%). Fewer than 10% of patients were treated with PRRT ¹⁷⁷Lu-dotatate or telotristat and 1% with a combination. Total healthcare cost increased from $12,376 to $25,647 (mean difference = $13,272 ±$24,189, p<0.001) for 1 month before/after treatment change, from $36,395 to $59,324 ($22,929 ±$41,764, p<0.001) for 3 months before/after, and from $66,786 to $109,224 ($42,438 ±$98,875, p<0.001) for 6 months before/after. Patients changing to targeted therapy had the largest 1 month interval cost increase ($19,677 ±$19,023, p<0.001) compared with patients changing to alternate SSA ($10,240 ±$14,112, p<0.001) and to chemotherapy ($4,057 ±$20,566, p=0.155). The differences were driven by increases in outpatient services and pharmacy prescriptions. Conclusions: The setting of rising costs after treatment change from SSA indicates treatment costs as the key driver, rather than NET disease severity. Future studies should investigate the clinical effectiveness of switching from SSA relative to the economic burden imposed by treatment change.

Ipsen Biopharmaceuticals.