HEALTH RESOURCE UTILIZATION BY PATIENTS WITH NEUROENDOCRINE TUMORS WITH OR WITHOUT CARCINOID HEART DISEASE

Background: Patients (pts) with neuroendocrine tumors (NET) and carcinoid syndrome may present carcinoid heart disease (CHD) as a late complication of tumor-related hormonal secretion. A multicenter study conducted by our group identified a frequency of CHD of 34.5% among Latin American pts and it was associated with increased mortality. However, the extent to which these pts utilize health resources has not been evaluated. Aim (s): To evaluate the types and frequencies of health resources used by NET pts, according to the presence of CHD. Methods: This was a multicentric study of consecutive pts treated in 7 hospitals in Latin America. The study sample was obtained from the database of all consecutive NET cases with elevated urinary 5HIAA from participating centers. CHD was defined as at least moderate right-valve regurgitation by an echocardiogram. We considered as health resource utilization (HRU) number of hospital visits, admissions and length of stay, number of echocardiograms and somatostatin analog use. Descriptive statistics were used to report pts characteristics. To compare HRU between pts with and without CHD, we used the chi-squared test for binary variables and variance analysis for quantitative correlations. Observations with missing data were excluded from the analyses. Results: 137 pts were evaluated: 41 (29.9%) with and 96 (70%) without CHD. Pts with and without CHD had, respectively: mean age of 59 and 54 years, 29 (21.2%) and 45 (32.9%) had cardiovascular comorbidities, 30 (21.8%) and 47 (34.3%) were female, 30 (21.9%) and 51 (37.2%) were treated in a public setting. Pts with vs without CHD presented: higher number of elective medical visits (N = 124, Mean: 37 vs 25; p = 0.017) and emergency visits (N = 124, Mean: 3.3 vs 2.2; p = 0.110), echocardiograms (N = 123, Mean: 4 vs 2; p = 0.0001). Pts with CHD were less frequently treated with somatostatin analogs (N = 136, 28.7% vs 60.3%; p = 0.04). The frequency of Intensive Care Unit admissions was similar between the groups. (p = 0.11). Conclusion: We found that pts with CHD experience much more HRU and are less often treated with somatostatin analogs when compared to pts without CHD. Given that CHD in Latin America is significantly more frequent in the public system, our data suggest that access to effective therapies is essential to reduce the incidence of CHD and consequently, HRU.