PIN57 Burden of NON-Tuberculous Mycobacterial LUNG Disease (NTMLD) in France: A Claim Database Analysis

Abstract

The objective of the study was to describe the epidemiology, management and cost of Non-tuberculous mycobacteria lung disease (NTMLD) in France. A retrospective analysis was performed using the SNIIRAM database over 2010-2017. NTMLD patients were identified based on the ICD10 codes during hospitalizations and/or specific antibiotics treatment regimens. The study population was matched (age, gender and region) to a control group (1: 3) without NTMLD. 5,628 NTMLD patients (men: 52.9%, mean age=60.9y) were identified. 1,433 patients (25.5%) were treated with antibiotics. The proportion of patients still treated at 6 and 12 months was 40% and 22%, respectively. NTMLD patients had more co-morbidities as compared to controls - the mean Charlson comorbidity index score was 1.6 (versus 0.2 for controls; p <0.0001). Risk factors comparisons between NTMPD cases and control group were statistically significant (p<0.0001): corticosteroids (57.3% vs 33.8%), Chronic lower respiratory diseases (34.4% vs 2.7%), other infectious pneumonia (24.4% vs 1.4%), malnutrition (22.0% vs 2.0%), tuberculosis (14.1% vs 0.1%), HIV (8.7% vs 0.2%), lung cancer and graft (5.7% vs 0.4%), cystic fibrosis (3.2% vs 0.0%), gastro-esophageal reflux disease (2.9% vs 0.9%) and bone marrow transplant (1.3% vs 0.0%). A higher 5-year mortality rate was observed in subjects with NTMLD: 19.7% versus 5.5% (p<0.0001, Log-Rank). Annual total expenses the year following the infection in a societal perspective were € 24,083 (SD: 29,358) in NTMLD subjects versus € 3,402 (SD: 8,575) in controls (p<0.0001). Main driver of the total expense for NTMLD patients was hospital expense (>50% of the total expense). NTMLD patients have high comorbidity burden, mortality and healthcare expenses. Only minority of patients get treated with antibiotics and many stop therapies before the infection can be successfully eradicated. These results underline the high burden associated with NTMLD and the need for appropriate management of this condition.