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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.
摘要：
背景：在美国，非结核性分枝杆菌肺病（NTMLD）的患病率有所增加；然而，在国家一级描述相关医疗保健利用和支出的数据是有限的。目的：在美国国家管理式医疗索赔数据库（Optum®Clinformatics®DataMart）中，研究经济结果与使用基于抗鸟分枝杆菌复合物（MAC）指南的新诊断NTMLD治疗（GBT）之间的关联。方法：NTMLD定义为间隔30天（2007年至2016年）在不同的场合有≥2次NTMLD（ICD-9031.0;ICD-10A31.0）索赔。该队列包括在至少36个月的时间内（在初始NTMLD诊断索赔之前的12个月以及随后的24个月）连续投保的患者。治疗被归类为GBT（符合美国胸科学会/美国传染病学会指南），非GBT,或未经处理。评估第2年的全因住院率和总医疗保健支出，作为NTMLD诊断后第1年规定的治疗结果。结果：共有1,039例患者符合NTMLD的研究标准（GBT，n=294；非GBT，n=298；未经处理，n=447)。调整基线特性后，GBT与全因住院风险显著低于非GBT相关(比值比[OR]=0.53;95%CI=0.33-0.85,p=0.008),和未治疗（OR=0.57；95%CI=0.35-0.91，p=0.020）。第2年GBT调整后的医疗总支出(69,691美元)低于非GBT(77,624美元)，差异为-7,933美元(95%CI=-14,968美元至-899美元；p=0.03)。结论：在美国管理式医疗索赔数据库中，接受GBT处方的NTMLD患者的住院风险低于接受非GBT处方或未经治疗的患者。与非GBT相比，GBT与较低的医疗总支出相关。
