Kwon Sun-Hong, Nam Jin Hyun, Kim Hye-Lin, Park Hae-Young, Kwon Jin-Won
School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
Division of Big Data Science, Korea University Sejong Campus, Sejong, South Korea.
Front Pharmacol. 2022 Aug 16;13:918344. doi: 10.3389/fphar.2022.918344. eCollection 2022.
We analyzed tuberculosis (TB)-related costs according to treatment adherence, as well as the association between treatment adherence, treatment outcomes, and costs related to drug-susceptible TB in South Korea. Patients who had newly treated TB in South Korea between 2006 and 2015 were selected from nationwide sample claims data and categorized into adherent and non-adherent groups using the proportion of days TB drugs covered. Patients were followed-up from the initiation of TB treatment. The mean five-year cumulative costs per patient were estimated according to adherence. Moreover, we evaluated the relative ratios to identify cost drivers such as adherence, treatment outcomes, and baseline characteristics using generalized linear models. Four treatment outcomes were included: treatment completion, loss to follow-up, death, and the initiation of multidrug-resistant TB treatment. Out of the 3,799 new patients with TB, 2,662 were adherent, and 1,137 were non-adherent. Five years after initiating TB treatment, the mean TB-related costs were USD 2,270 and USD 2,694 in the adherent and non-adherent groups, respectively. The TB-related monthly cost per patient was also lower in the adherent than in the non-adherent (relative ratio = 0.89, 95% CI 0.92-0.98), while patients who were lost to follow-up spent more on TB-related costs (2.52, 2.24-2.83) compared to those who completed the treatment. Non-adherent patients with TB spend more on treatment costs while they have poorer outcomes compared to adherent patients with TB. Improving patient adherence may lead to effective treatment outcomes and reduce the economic burden of TB. Policymakers and providers should consider commitment programs to improve patient's adherence.
我们根据治疗依从性分析了韩国结核病（TB）相关成本，以及治疗依从性、治疗结果与药物敏感型结核病相关成本之间的关联。从全国样本理赔数据中选取了2006年至2015年间在韩国新接受结核病治疗的患者，并根据结核病药物覆盖天数的比例将其分为依从组和非依从组。从结核病治疗开始对患者进行随访。根据依从性估算了每位患者五年的平均累积成本。此外，我们使用广义线性模型评估了相对比率，以确定如依从性、治疗结果和基线特征等成本驱动因素。纳入了四种治疗结果：治疗完成、失访、死亡以及耐多药结核病治疗的启动。在3799例新的结核病患者中，2662例为依从性患者，1137例为非依从性患者。开始结核病治疗五年后，依从组和非依从组的平均结核病相关成本分别为2270美元和2694美元。依从组每位患者每月的结核病相关成本也低于非依从组（相对比率 = 0.89，95%可信区间0.92 - 0.98），而失访患者的结核病相关成本高于完成治疗的患者（2.52，2.24 - 2.83）。与结核病依从性患者相比，结核病非依从性患者治疗成本更高，而治疗结果更差。提高患者依从性可能会带来有效的治疗结果，并减轻结核病的经济负担。政策制定者和医疗服务提供者应考虑实施促进项目以提高患者的依从性。
