Treatment Patterns of Long-Acting Somatostatin Analogs for Neuroendocrine Tumors

**Background:** Long-acting somatostatin analog therapy (LA-SSA) is recommended as first-line therapy for treatment of unresectable or metastatic neuroendocrine tumors (NETs). Understanding treatment sequencing and dosing patterns of LA-SSA is essential for clinical decision-making to provide value-based management of NETs. **Objective:** To describe treatment patterns of LA-SSA among patients with NETs and subgroups with carcinoid syndrome (CS) in the United States. **Methods:** This retrospective study utilized claims data from MarketScan® databases to identify patients with NETs and newly treated with LA-SSA between January 1, 2015, and October 31, 2020. Patients were stratified by index LA-SSA (lanreotide and octreotide long-acting release $$LAR$$). Reported 28-day doses were based on claim fields for days’ supply/drug quantity or units of service. Dose escalation was defined as increases in quantity or frequency. Continuous variables, categorical variables, and Kaplan-Meier estimated treatment durations were compared using _t_-tests, chi-square/Fisher’s tests, and log-rank tests, respectively. **Results:** The study included 241 lanreotide and 521 octreotide LAR patients. Compared with octreotide LAR patients, treatment duration was longer for lanreotide patients (median, 41.3 vs 26.8 months; log-rank _p_=.004). Fewer lanreotide patients received rescue treatment with short-acting octreotide (7.9% vs 14.4%; _p_=.011), and a first (6.2% vs 27.3%) and second dose escalation (0.8% vs 5.2%; both _p_<.05). Among patients with doses reported, fewer lanreotide patients received above-label doses (2.5% $$5/202$$ vs 14.4% $$60/416$$; _p_<.001). Among patients who ended treatment during follow-up, fewer lanreotide patients transitioned to another LA-SSA (18.9% $$17/90$$ vs 33.6% $$92/274$$; _p_=.008). Similar treatment patterns were observed in CS subgroups. Results for switched treatment patterns were limited due to insufficient sample sizes. **Discussion:** Real-world treatment patterns of LA-SSA were assessed using more recent administrative claims data. Compared with octreotide LAR patients, lanreotide patients were more likely to remain longer on initial treatment and starting dose without dose escalations and less likely to use rescue treatment and transition to another LA-SSA after discontinuation of the index treatment. **Conclusions:** Findings from this claims study suggest a potential clinical benefit of lanreotide in NET management

Planning opportunities with the Sec. 121 Partial Exclusion.

Sec. 121 allows taxpayers to exclude up to $250,000 ($500,000 for married taxpayers filing jointly and surviving spouses) of gain from the sale of a principal residence. This article discusses the requirements to qualify for the exclusion of gain and the partial exclusion of gain available in certain circumstances to taxpayers that do not meet the requirements for the full exclusion

A Critical Review of Published Economic Modelling Studies in Depression

Depression is a very costly chronic disease. An important cost driver is treatment failure caused by patient noncompliance due, in part, to the adverse effects of medications. Additionally, inadequate duration of therapy and inappropriate medication switching contribute to the high cost of treatment. With the epidemiological data for depression demonstrating a rise in both incidence and prevalence over the last 20 years, and the fact that many of the newer antidepressants will see patent expiry in the near future, previous antidepressant cost-effectiveness scenarios are likely to change. As economic models play an increasingly important role in therapeutic decision-making, clinicians are encouraged to understand the strategies and methods involved in modelling antidepressant therapy. The aim of this review of the literature and synthesis of the various techniques important to the modelling of antidepressant therapies is for the practitioner to gain an increased understanding of the modelling methods previously utilised and be in a position to better evaluate future health economic models for the treatment of depression.Antidepressants, Citalopram, Decision analysis, Depression, Dothiepin, Fluoxetine, Imipramine, Modelling, Nefazodone, Paroxetine, Pharmacoeconomics, Sertraline, Tricyclic antidepressants, Venlafaxine