Guidelines-based treatment associated with improved economic outcomes in nontuberculous mycobacterial lung disease

Theodore K. Marras, Mehdi Mirsaeidi, Christopher Vinnard, Edward D. Chan, Gina Eagle, Raymond Zhang, Ping Wang, Quanwu Zhang

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: 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.

Original languageEnglish (US)
Pages (from-to)1126-1133
Number of pages8
JournalJournal of Medical Economics
Volume22
Issue number11
DOIs
StatePublished - Nov 2 2019

Keywords

  • Cost
  • expenditure
  • healthcare utilization
  • hospitalization
  • non-tuberculous mycobacteria
  • pulmonary

ASJC Scopus subject areas

  • Health Policy

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