Department of Medicine, University Health Network and Mount Sinai Hospital , Toronto , ON , Canada.
Department of Medicine, University of Toronto , Toronto , ON , Canada.
J Med Econ. 2019 Nov;22(11):1126-1133. doi: 10.1080/13696998.2019.1620243. Epub 2019 Jun 10.
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. To examine associations between economic outcomes and the use of anti- complex (MAC) guidelines-based treatment (GBT) for newly-diagnosed NTMLD in a US national managed care claims database (Optum Clinformatics Data Mart). 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. A total of 1,039 patients met study criteria for NTMLD (GBT, = 294; non-GBT, = 298; untreated, = 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, = 0.008), and vs being untreated (OR = 0.57; 95% CI = 0.35-0.91, = 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; = 0.03). 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.
非结核分枝杆菌肺病（NTMLD）在美国的患病率有所增加；然而，在全国范围内描述与这种疾病相关的医疗保健利用和支出的数据十分有限。本研究旨在利用美国全国管理式医疗索赔数据库（Optum Clinformatics Data Mart），通过分析新诊断为 NTMLD 患者的经济结果与使用抗复杂（MAC）指南为基础的治疗（GBT）之间的关联，对这一问题进行研究。NTMLD 的定义为：在 2007 年至 2016 年期间，两次相隔至少 30 天（分别在首次 NTMLD 诊断索赔前 12 个月和随后 24 个月），有≥2 次 NTMLD（ICD-9 031.0；ICD-10 A31.0）的单独索赔。该队列包括至少连续 36 个月（首次 NTMLD 诊断索赔前 12 个月和随后 24 个月）有保险的患者。治疗被分为 GBT（符合美国胸科学会/传染病学会指南）、非 GBT 和未治疗。在 NTMLD 诊断后第一年规定的治疗方案下，第二年的全因住院率和总医疗保健支出被评估为治疗的结果。共有 1039 名患者符合 NTMLD 研究标准（GBT，n=294；非 GBT，n=298；未治疗，n=447）。在调整了基线特征后，GBT 与非 GBT（比值比[OR] = 0.53；95%置信区间[CI] = 0.33-0.85，P=0.008）和未治疗（OR = 0.57；95% CI = 0.35-0.91，P=0.020）相比，全因住院风险显著降低。在第二年，GBT 的总医疗保健支出（69691 美元）低于非 GBT（77624 美元），差值为-7933 美元（95% CI = -14968 美元至-899 美元；P=0.03）。在一个美国管理式医疗索赔数据库中，患有 NTMLD 的患者接受 GBT 治疗比接受非 GBT 治疗或未接受治疗的患者的住院风险更低。与非 GBT 相比，GBT 与较低的总医疗保健支出相关。
