Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
Lung Clinic Grosshansdorf, Airway Disease Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany.
Eur Respir J. 2017 Apr 26;49(4). doi: 10.1183/13993003.02109-2016. Print 2017 Apr.
The objective of this study was to estimate the burden of disease in incident patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD).A sample of 7 073 357 anonymised persons covered by German public statutory health insurances was used to identify patients with NTM-PD. In total, 125 patients with newly diagnosed NTM-PD in 2010 and 2011 were matched with 1250 control patients by age, sex and Charlson Comorbidity Index, and followed for 39 months.The incidence rate for NTM-PD was 2.6 per 100 000 insured persons (95% CI 2.2-3.1). The mortality rate for patients with NTM-PD and the control group in the observational period was 22.4% and 6%, respectively (p<0.001). Mean direct expenditure per NTM-PD patient was €39 559.60 (95% CI 26 916.49-52 202.71), nearly 4-fold (3.95, 95% CI 3.73-4.19) that for a matched control (€10 006.71, 95% CI 8907.24-11 106.17). Hospitalisations were three times higher in the NTM-PD group and accounted for 63% of the total costs. Attributable annual direct costs and indirect work-loss costs in NTM-PD patients were €9093.20 and €1221.05 per control patient, respectively. Only 74% of NTM-PD patients received antibiotics and nearly 12% were prescribed macrolide monotherapy.Although NTM-PD is considered rare, the attributable mortality and financial burden in Germany are high. Efforts to heighten awareness of appropriate therapy are urgently needed.
本研究旨在评估非结核分枝杆菌性肺病（NTM-PD）新发病例患者的疾病负担。利用德国公共法定健康保险覆盖的 7073357 名匿名患者样本，识别出 2010 年和 2011 年新诊断为 NTM-PD 的 125 名患者，并通过年龄、性别和 Charlson 合并症指数与 1250 名对照患者进行匹配，随访 39 个月。NTM-PD 的发病率为每 100000 名参保人 2.6 例（95%CI 2.2-3.1）。在观察期内，NTM-PD 患者和对照组的死亡率分别为 22.4%和 6%（p<0.001）。每位 NTM-PD 患者的平均直接支出为 39559.60 欧元（95%CI 26916.49-52202.71），几乎是匹配对照患者的 4 倍（3.95，95%CI 3.73-4.19）（10006.71 欧元，95%CI 8907.24-11106.17）。NTM-PD 组的住院率高 3 倍，占总费用的 63%。NTM-PD 患者的归因年度直接费用和间接工作损失成本分别为每个对照患者 9093.20 欧元和 1221.05 欧元。只有 74%的 NTM-PD 患者接受了抗生素治疗，近 12%的患者接受了大环内酯类单药治疗。尽管 NTM-PD 被认为很少见，但德国的归因死亡率和财政负担很高。迫切需要努力提高对适当治疗的认识。
