The high costs of a lung disease caused by organisms in soil and water has been revealed for the first time in a European study.
The research into non-tuberculosis mycobacterium pulmonary disease (NTM-PD) has shown that both the three-year all-cause mortality rate and financial burden for patients with the disease is almost four times higher than a matched control group.
Dr Michael Loebinger of the Royal Brompton Hospital, London, who is one of the authors of the study published in the European Respiratory Journal, said their findings demonstrate that the burden is high.
Over 39 months, researchers compared 125 newly diagnosed NTM-PD patients with 1,250 control patients matched by age, gender and Charlson Comorbidity Index.
During this time period the all-cause mortality rate for those diagnosed with NTM-PD was 22.4%, almost four times higher than the matched control group, at 6%.
Over the same period, the all-cause mortality rate in COPD patients who had NTM-PD was 41.5% (27/65 patients) but was only 15.9% (62/390) in COPD patients without NTM-PD, meaning direct expenditure for an NTM-PD patient was €39,559.60 over 39 months compared with €10,006.71 in the matched control group.
Hospitalisations were also three times higher for NTM-PD patients and accounted for 63% of expenditure, with drug costs being the second biggest costs.
Clarithromycin combined with ethambutol was the most frequently prescribed treatment option, followed by standard treatment clarithromycin plus rifampicin plus ethambutol or rifabutin plus ethambutol.
Dr Loebinger said: “Although NTM-PD is considered rare, these findings highlight that the burden of the disease is high. Treatment can be hard to tolerate and may be unsuccessful, making treatment decisions complex.”
The British Thoracic Society will release new guidelines this year, he added.
NTM is caused by ubiquitous mycobacteria found in the soil and water. More than 150 species of NTM have been identified and mycobacterium avium complex (MAC) has been reported to be the most common causative agent in NTM-PD worldwide.
Diseases caused by NTMs represent a growing diagnostic and clinical challenge. Over the past few decades, incidence, prevalence, hospitalisation rate, and mortality rate of NTM-PD have increased globally.
Diel R, Jacob J, Lampenius N et al. Burden of non-tuberculous mycobacterial pulmonary disease in Germany. European Respiratory Journal 3 May 2017
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