Guidelines-based treatment associated with improved economic outcomes in nontuberculous mycobacterial lung disease |
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| Authors: | Theodore K. Marras Mehdi Mirsaeidi Christopher Vinnard Edward D. Chan Gina Eagle Raymond Zhang |
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| Affiliation: | 1. Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada;2. Department of Medicine, University of Toronto, Toronto, ON, Canada;3. ted.marras@uhn.ca;5. Pulmonary and Critical Care, University of Miami, Coral Gables, FL, USA;6. Public Health Research Institute, Rutgers, The State University of New Jersey, Newark, NJ, USA;7. Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA;8. National Jewish Health, Denver, CO, USA;9. Insmed Incorporated, Bridgewater, NJ, USA;10. Orbis Data Solutions, Woburn, MA, USA |
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| Abstract: | AbstractBackground: The prevalence of nontuberculous mycobacterial lung disease (NTMLD) in the US has increased; however, data characterizing the associated healthcare utilization and expenditure at the national level are limited.Objective: To examine associations between economic outcomes and the use of anti-Mycobacterium avium complex (MAC) guidelines-based treatment (GBT) for newly-diagnosed NTMLD in a US national managed care claims database (Optum® Clinformatics® Data Mart).Methods: NTMLD was defined as having ≥2 claims for NTMLD (ICD-9 031.0; ICD-10 A31.0) on separate occasions ≥30?days apart (between 2007 and 2016). The cohort included patients insured continuously over a period of at least 36?months (12?months before initial NTMLD diagnostic claim and for the subsequent 24?months). Treatment was classified as GBT (consistent with American Thoracic Society/Infectious Diseases Society of America guidelines), non-GBT, or untreated. All-cause hospitalization rates and total healthcare expenditures at Year 2 were assessed as outcomes of the treatment prescribed in Year 1 after NTMLD diagnosis.Results: A total of 1,039 patients met study criteria for NTMLD (GBT, n?=?294; non-GBT, n?=?298; untreated, n?=?447). After adjustment for baseline characteristics, GBT was associated with a significantly lower all-cause hospitalization risk vs non-GBT (odds ratio [OR]?=?0.53; 95% CI = 0.33–0.85, p?=?0.008), and vs being untreated (OR = 0.57; 95% CI = 0.35–0.91, p?=?0.020). Adjusted total healthcare expenditure in Year 2 with GBT ($69,691) was lower than that with non-GBT ($77,624) with a difference of ?$7,933 (95% CI = ?$14,968 to ?$899; p?=?0.03).Conclusions: Patients with NTMLD in a US managed care claims database who were prescribed GBT had lower hospitalization risk than those who were prescribed non-GBT or were untreated. GBT was associated with lower total healthcare expenditure compared with non-GBT. |
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| Keywords: | Cost expenditure healthcare utilization hospitalization non-tuberculous mycobacteria pulmonary |
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