Guidelines-based treatment associated with improved economic outcomes in nontuberculous mycobacterial lung disease.
J Med Econ
; 22(11): 1126-1133, 2019 Nov.
Article
em En
| MEDLINE
| ID: mdl-31094592
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.Palavras-chave
Texto completo:
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Temas:
ECOS
/
Aspectos_gerais
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Estado_mercado_regulacao
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Macrolídeos
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Infecções por Mycobacterium não Tuberculosas
/
Antituberculosos
Tipo de estudo:
Guideline
/
Health_economic_evaluation
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Med Econ
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Canadá