Guidelines-based treatment associated with improved economic outcomes in non-tuberculous 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 journalArticle

Abstract

Background: The prevalence of non-tuberculous 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 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)
JournalJournal of Medical Economics
DOIs
StatePublished - Jan 1 2019

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Keywords

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

ASJC Scopus subject areas

  • Health Policy

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