Pulmonary nontuberculous mycobacterial infections: Antibiotic treatment and associated costs

被引:75
作者
Ballarino, Guillermo J. [2 ]
Olivier, Kenneth N.
Claypool, Reginald J.
Holland, Steven M.
Prevots, D. Rebecca [1 ]
机构
[1] NIAID, Epidemiol Unit, Lab Clin Infect Dis, NIH,US Dept HHS, Bethesda, MD 20892 USA
[2] George Washington Univ, Med Ctr, Dept Med, Washington, DC 20037 USA
关键词
Mycobacteria; atypical; Nontuberculous mycobacteria; Anti mycobacterial. agents; Health-care costs; Drug toxicity; Mycobacterium avium complex; UNITED-STATES; DISEASES; HIV; EPIDEMIOLOGY; SPECIMENS; DIAGNOSIS; CARE;
D O I
10.1016/j.rmed.2009.04.026
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. Published by Elsevier Ltd.
引用
收藏
页码:1448 / 1455
页数:8
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