Incidence and prevalence of neuroendocrine tumors of the lung: analysis of a US commercial insurance claims database

Abstract

Background: As reported in Surveillance, Epidemiology, and End Results (SEER) data, US incidence and prevalence of neuroendocrine tumors (NET) has increased over recent years. The study objective was to update incidence and prevalence information for lung NET using administrative claims.

Methods: This descriptive epidemiological study used 2009-2014 data from 2 US claims databases: MarketScan and PharMetrics. Patients (18-64 years old) had ≥1 inpatient or ≥ 2 outpatient claims with NET of bronchus or lung, identified by International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Prevalence was number of lung NET patients divided by number of enrollees/year. Incidence was number of patients with a first observed NET diagnosis who were disease-free for 2 years prior, divided by number of enrollees. Age and gender adjustments performed.

Results: The annual number of patients with lung NET identified from 2009 to 2014 ranged from 435 to 796 (MarketScan) and 419-648 (PharMetrics). In MarketScan, there was a 7.4% (95%CI 2.1-13.0; p = 0.027) annual percent change (APC) in the age-adjusted incidence for males and 6.8% (- 0.2-14.3; 0.052) for females. In PharMetrics, APC was - 2.9% (- 13.8-9.4; 0.395) for males; 14.7% (- 12.9-51.2; 0.165) for females. In MarketScan, APC in age-adjusted prevalence for males was 9.9% (4.7-15.3; 0.006); 16.2% (11.4-21.1; <.001) for females. For PharMetrics, APCs were 9.5% (2.3-17.2; 0.021) for males; 16.3% (9.6-23.5; 0.002) for females.

Conclusions: From 2009 to 2014 there was a statistically significant increase in age-adjusted lung NET incidence for males in MarketScan, and a statistically significant increase in age-adjusted prevalence for both genders in PharMetrics. Incidence and prevalence changes, to the extent they exist, may be due to better diagnostic methods, increased awareness of NET among clinicians and pathologists, and/or an actual increase in US disease occurrence. Differences in rates across databases are difficult to explain. These results suggest the need for awareness of the clinically effective and safe treatment options available for lung NET patients among healthcare providers.

Keywords: Epidemiology; Incidence; Insurance claims; Lung neuroendocrine tumors; Prevalence.

Fig. 1

Lung NET Incidence Rate, Cases per Million Person-Years^a. ^a In the combined database (adjusted for age and gender) the no. of cases per million person-years was 13.0 (2011), 14.5 (2012), 15.9 (2013), and 16.2 (2014) for all patients. ^b Adjusted based on distribution of age among males from both databases in 2014. ^c Adjusted based on distribution of age among females from both databases in 2014

Fig. 2

Lung NET Prevalence, Cases per Million/Year^a. ^a In the combined database (adjusted for age and gender) the no. of cases per million per year was 14.6 (2009), 18.4 (2010), 21.3 (2011), 24.6 (2012), 26.9 (2013), and 28.5 (2014) for all patients. ^b Adjusted based on distribution of age among males from both databases in 2014. ^c Adjusted based on distribution of age among females from both databases in 2014