背景:非结核性分枝杆菌肺病(NTMLD)的治疗包括长期的多药抗生素方案,然而,许多患者没有实现文化转换。我们估计了加拿大与NTMLD相关的直接医疗费用,法国,德国,和英国(UK)在感染鸟分枝杆菌复合体(MAC)的难治性患者中,没有伴随的囊性纤维化,结核病,或艾滋病毒。
方法:我们对全国代表性样本进行了回顾性观察性医师调查。该调查捕获了有关患者在24个月内使用NTMLD相关医疗保健资源的治疗历史的匿名信息。我们总结了与NTMLD相关的资源使用,并估计了总的经济负担,从每个国家的医疗保健支付者的角度来看。
结果:总计,59名医生提供了157名患者的数据。在24个月期间观察到的平均时间为1.7年(SD:0.4);在研究期结束时,有17%的患者死亡。在难治性患者中,与NTMLD相关的直接医疗费用的主要组成部分是住院(从英国的总年度费用的29%到法国的69%),门诊就诊(加拿大为8%,英国为51%),和门诊检测,如诊断后痰检测,支气管冲洗/灌洗,肺活量测定,活检,成像,和心电图(法国为5%,加拿大为35%)。在这个患者队列中,每人每年的平均直接医疗费用,以当地货币,大约$16,200(加拿大),€11,600(德国),17,900欧元(法国)和9,700英镑(英国)。
结论:根据本研究的结果,我们得出的结论是,管理由MAC引起的难治性NTMLD患者会带来巨大的经济负担.
BACKGROUND: Management of nontuberculous mycobacterial lung disease (NTMLD) consists of a long-term multi-drug antibiotic regimen, yet many patients do not achieve culture conversion. We estimated the NTMLD-related direct medical costs in Canada, France, Germany, and the United Kingdom (UK) among refractory patients who were infected with Mycobacterium avium complex (MAC), without concomitant cystic fibrosis, tuberculosis, or HIV.
METHODS: We conducted a retrospective observational physician survey of nationally representative samples. The survey captured anonymized information about patients\' treatment histories for NTMLD-related health care resource utilization over a 24-month period. We summarized NTMLD-related resource use and estimated the total economic burden, from each country\'s health care payer perspective.
RESULTS: In total, 59 physicians provided data on 157 patients. The average person time observed during the 24-month period was 1.7 years (SD: 0.4); 17% of patients died by the end of the
study period. The major components of NTMLD-related direct medical costs among refractory patients were hospitalizations (varying from 29% of total annual costs in the UK to 69% in France), outpatient visits (8% in Canada to 51% in the UK), and outpatient testing such as post-diagnostic sputum testing, bronchial wash/lavage, spirometry, biopsies, imaging, and electrocardiograms (5% in France to 35% in Canada). In this patient cohort, the average direct medical costs per person-year, in local currencies, were approximately $16,200 (Canada), €11,600 (Germany), €17,900 (France) and £9,700 (UK).
CONCLUSIONS: Based on this
study\'s findings, we conclude that managing patients with refractory NTMLD caused by MAC is associated with a substantial economic burden.