Background Somatostatin analogues such as Octreotide are used in Palliative care to support symptom management as an anti-secretory agent in the context of malignant bowel obstruction. This is usually given via a continuous subcutaneous infusion over 24 hours. There are also depot preparations available, however locally these haven’t been used in this context.
Methods We reviewed the clinical effectiveness and financial cost of using somatostatin analogue depots in two patients known to the Coventry Community Palliative Care team.
Results Two patients received somatostatin analogue depots over a three month period, with prior titration of an Octreotide syringe driver for three months. Both patients had requested other ways to manage their symptoms other than a syringe driver. The indications were for malignant bowel obstruction and management of immunotherapy related diarrhoea. A 20 mg octreotide depot provided clinically significant benefit in management of immunotherapy related diarrhoea and improvement of symptom control beyond that of the syringe driver. Which provided increased freedom and quality of life. A 60 mg Lanreotide depot was administered which provided equal symptom control and reduced the burden of syringe drivers from two to one. The financial costs to administer Octreotide syringe driver with 2 nurses is £84.53 per day for 500 microgram and £107.56 per day for a 750 microgram to 1 mg. The Octreotide depot costs £26.49 per day and a Lanreotide depot costs £20.48 per day. This means that using a depot can save up to £87.08 per day in healthcare costs
Conclusions Somatostatin analogue depots can be a clinically and cost-effective way of managing symptoms. From our experience we would suggest titration with Octreotide to a stable dose and then consider a switch to a depot. There is further research needed to be conducted into the effectiveness of these depot preparations.
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