Pulmonary nontuberculous mycobacterial infections: Antibiotic treatment and associated costs
Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatme...
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| Published in | Respiratory medicine Vol. 103; no. 10; pp. 1448 - 1455 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kidlington
Elsevier Ltd
01.10.2009
Elsevier Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatment and to identify risk factors associated with increased costs. Records from subjects with pulmonary NTM disease enrolled in a natural history protocol were abstracted for presenting symptoms, comorbidities, microbiology, and treatment histories. Antibiotic frequency, duration, adverse reaction, and costs were noted, the total antibiotic burden and cost were calculated, and risk factors associated with high costs were analyzed. From Jan 2004 to Dec 2005, 33 subjects were enrolled; 27 met disease criteria and had sufficient data to assess antibiotic use.
Mycobacterium avium complex was present in 89% and
Mycobacterium abscessus was present in 21% of subjects. Subjects received a median of 5 (1–10) antibiotics. Adverse effects were common seen in up to 50% with common antibiotics and up to 100% with uncommonly used antibiotics. Median burden of treatment was 2638 (84–7689) drug-days and the median total cost per patient was $19,876 ($398–70,917). Subjects with high treatment costs had an adjusted 9.5 fold (95% CI 1.5–97.2) likelihood of having
M. abscessus and a 4.2 fold (95% CI 0.6–59.3) increased likelihood of having more extensive disease. Pulmonary NTM represent an underappreciated disease burden in the US population, with an associated treatment cost comparable to that for other chronic diseases of infectious origin such as HIV/AIDS. |
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| AbstractList | Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatment and to identify risk factors associated with increased costs. Records from subjects with pulmonary NTM disease enrolled in a natural history protocol were abstracted for presenting symptoms, comorbidities, microbiology, and treatment histories. Antibiotic frequency, duration, adverse reaction, and costs were noted, the total antibiotic burden and cost were calculated, and risk factors associated with high costs were analyzed. From Jan 2004 to Dec 2005, 33 subjects were enrolled; 27 met disease criteria and had sufficient data to assess antibiotic use.
Mycobacterium avium complex was present in 89% and
Mycobacterium abscessus was present in 21% of subjects. Subjects received a median of 5 (1–10) antibiotics. Adverse effects were common seen in up to 50% with common antibiotics and up to 100% with uncommonly used antibiotics. Median burden of treatment was 2638 (84–7689) drug-days and the median total cost per patient was $19,876 ($398–70,917). Subjects with high treatment costs had an adjusted 9.5 fold (95% CI 1.5–97.2) likelihood of having
M. abscessus and a 4.2 fold (95% CI 0.6–59.3) increased likelihood of having more extensive disease. Pulmonary NTM represent an underappreciated disease burden in the US population, with an associated treatment cost comparable to that for other chronic diseases of infectious origin such as HIV/AIDS. Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatment and to identify risk factors associated with increased costs. Records from subjects with pulmonary NTM disease enrolled in a natural history protocol were abstracted for presenting symptoms, comorbidities, microbiology, and treatment histories. Antibiotic frequency, duration, adverse reaction, and costs were noted, the total antibiotic burden and cost were calculated, and risk factors associated with high costs were analyzed. From Jan 2004 to Dec 2005, 33 subjects were enrolled; 27 met disease criteria and had sufficient data to assess antibiotic use. Mycobacterium avium complex was present in 89% and Mycobacterium abscessus was present in 21% of subjects. Subjects received a median of 5 (1-10) antibiotics. Adverse effects were common seen in up to 50% with common antibiotics and up to 100% with uncommonly used antibiotics. Median burden of treatment was 2638 (84-7689) drug-days and the median total cost per patient was $19,876 ($398-70,917). Subjects with high treatment costs had an adjusted 9.5 fold (95% CI 1.5-97.2) likelihood of having M. abscessus and a 4.2 fold (95% CI 0.6-59.3) increased likelihood of having more extensive disease. Pulmonary NTM represent an underappreciated disease burden in the US population, with an associated treatment cost comparable to that for other chronic diseases of infectious origin such as HIV/AIDS.Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatment and to identify risk factors associated with increased costs. Records from subjects with pulmonary NTM disease enrolled in a natural history protocol were abstracted for presenting symptoms, comorbidities, microbiology, and treatment histories. Antibiotic frequency, duration, adverse reaction, and costs were noted, the total antibiotic burden and cost were calculated, and risk factors associated with high costs were analyzed. From Jan 2004 to Dec 2005, 33 subjects were enrolled; 27 met disease criteria and had sufficient data to assess antibiotic use. Mycobacterium avium complex was present in 89% and Mycobacterium abscessus was present in 21% of subjects. Subjects received a median of 5 (1-10) antibiotics. Adverse effects were common seen in up to 50% with common antibiotics and up to 100% with uncommonly used antibiotics. Median burden of treatment was 2638 (84-7689) drug-days and the median total cost per patient was $19,876 ($398-70,917). Subjects with high treatment costs had an adjusted 9.5 fold (95% CI 1.5-97.2) likelihood of having M. abscessus and a 4.2 fold (95% CI 0.6-59.3) increased likelihood of having more extensive disease. Pulmonary NTM represent an underappreciated disease burden in the US population, with an associated treatment cost comparable to that for other chronic diseases of infectious origin such as HIV/AIDS. Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatment and to identify risk factors associated with increased costs. Records from subjects with pulmonary NTM disease enrolled in a natural history protocol were abstracted for presenting symptoms, comorbidities, microbiology, and treatment histories. Antibiotic frequency, duration, adverse reaction, and costs were noted, the total antibiotic burden and cost were calculated, and risk factors associated with high costs were analyzed. From Jan 2004 to Dec 2005, 33 subjects were enrolled; 27 met disease criteria and had sufficient data to assess antibiotic use. Mycobacterium avium complex was present in 89% and Mycobacterium abscessus was present in 21% of subjects. Subjects received a median of 5 (1-10) antibiotics. Adverse effects were common seen in up to 50% with common antibiotics and up to 100% with uncommonly used antibiotics. Median burden of treatment was 2638 (84-7689) drug-days and the median total cost per patient was $19,876 ($398-70,917). Subjects with high treatment costs had an adjusted 9.5 fold (95% CI 1.5-97.2) likelihood of having M. abscessus and a 4.2 fold (95% CI 0.6-59.3) increased likelihood of having more extensive disease. Pulmonary NTM represent an underappreciated disease burden in the US population, with an associated treatment cost comparable to that for other chronic diseases of infectious origin such as HIV/AIDS. Summary Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public health burden of pulmonary NTM disease is difficult to assess. The goal of this study was to assess costs associated with NTM disease treatment and to identify risk factors associated with increased costs. Records from subjects with pulmonary NTM disease enrolled in a natural history protocol were abstracted for presenting symptoms, comorbidities, microbiology, and treatment histories. Antibiotic frequency, duration, adverse reaction, and costs were noted, the total antibiotic burden and cost were calculated, and risk factors associated with high costs were analyzed. From Jan 2004 to Dec 2005, 33 subjects were enrolled; 27 met disease criteria and had sufficient data to assess antibiotic use. Mycobacterium avium complex was present in 89% and Mycobacterium abscessus was present in 21% of subjects. Subjects received a median of 5 (1–10) antibiotics. Adverse effects were common seen in up to 50% with common antibiotics and up to 100% with uncommonly used antibiotics. Median burden of treatment was 2638 (84–7689) drug-days and the median total cost per patient was $19,876 ($398–70,917). Subjects with high treatment costs had an adjusted 9.5 fold (95% CI 1.5–97.2) likelihood of having M. abscessus and a 4.2 fold (95% CI 0.6–59.3) increased likelihood of having more extensive disease. Pulmonary NTM represent an underappreciated disease burden in the US population, with an associated treatment cost comparable to that for other chronic diseases of infectious origin such as HIV/AIDS. |
| Author | Claypool, Reginald J. Olivier, Kenneth N. Ballarino, Guillermo J. Holland, Steven M. Prevots, D. Rebecca |
| AuthorAffiliation | 1 Department of Medicine, George Washington University Medical Center, 2300 Eye St NW, Washington, DC 20037 2 Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1888 |
| AuthorAffiliation_xml | – name: 2 Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1888 – name: 1 Department of Medicine, George Washington University Medical Center, 2300 Eye St NW, Washington, DC 20037 |
| Author_xml | – sequence: 1 givenname: Guillermo J. surname: Ballarino fullname: Ballarino, Guillermo J. organization: Department of Medicine, George Washington University Medical Center, 2300 Eye St NW, Washington, DC 20037, USA – sequence: 2 givenname: Kenneth N. surname: Olivier fullname: Olivier, Kenneth N. organization: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1888, USA – sequence: 3 givenname: Reginald J. surname: Claypool fullname: Claypool, Reginald J. organization: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1888, USA – sequence: 4 givenname: Steven M. surname: Holland fullname: Holland, Steven M. organization: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1888, USA – sequence: 5 givenname: D. Rebecca surname: Prevots fullname: Prevots, D. Rebecca email: rprevots@niaid.nih.gov organization: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD 20892-1888, USA |
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| Keywords | Mycobacterium avium complex Mycobacteria, atypical Antimycobacterial agents Drug toxicity Nontuberculous mycobacteria Health-care costs Costs Toxicity Lung Mycobacterial infection Bacteria Public health Pneumology Drug Mycobacterium avium Complexes Care Infection Antibiotic Treatment Mycobacteriales Health economy Bacteriosis Mycobacteriaceae Actinomycetes Atypical |
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| Snippet | Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the public... Summary Recent studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease. In the absence of prevalence and cost data, the... |
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| SubjectTerms | Adult Aged Aged, 80 and over Anti-Bacterial Agents - economics Anti-Bacterial Agents - therapeutic use Antimycobacterial agents Bacterial diseases Biological and medical sciences Chronic Disease - drug therapy Chronic Disease - economics Drug toxicity Female Health Care Costs Human bacterial diseases Humans Infectious diseases Lung Diseases - drug therapy Lung Diseases - economics Lung Diseases - microbiology Male Medical sciences Middle Aged Mycobacteria, atypical Mycobacterium avium complex Mycobacterium avium-intracellulare Infection - drug therapy Mycobacterium avium-intracellulare Infection - economics Mycobacterium avium-intracellulare Infection - microbiology Nontuberculous mycobacteria Pneumology Practice Guidelines as Topic Pulmonary/Respiratory Risk Factors Tuberculosis and atypical mycobacterial infections |
| Title | Pulmonary nontuberculous mycobacterial infections: Antibiotic treatment and associated costs |
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