title: The cost of medical management of pulmonary nontuberculous mycobacterial disease in Ontario, Canada.
abstract: Treatment of pulmonary nontuberculous mycobacterial (NTM) infection is complex, requiring multiple antibiotics and a prolonged treatment course. We determined the monthly cost of treating patients with pulmonary NTM infections in our clinic, a tertiary care centre in Toronto, Ontario, Canada. We reviewed records of a single clinic at the University Health Network (Toronto) for all patients with pulmonary NTM isolates. Pharmacological and nonpharmacological treatment costs were calculated using a number of Canadian references. 172 patients were reviewed, 91 of whom were treated pharmacologically. The median total duration and cost per treated patient were 14 months (interquartile range (IQR) 9-23 months) and CAD 4,916 (IQR CAD 2,934-9,063), respectively. Median monthly drug treatment cost was CAD 321 (IQR CAD 254-458) for all patients, CAD 289 (IQR CAD 237-341) for patients receiving exclusively oral antibiotics and CAD 1,161 (IQR CAD 795-1,646) for patients whose treatment included i.v. antibiotics. The most costly oral regiment consisted of a fluroquinolone, macrolide and rifampin. In multivariable analysis, Mycobacterium abscessus infection, i.v. therapy and Mycobacterium xenopi infection were all associated with increased monthly treatment costs. The direct medical costs of NTM infections are substantial. Less expensive alternative therapies might be most helpful for M. abscessus infection and when i.v. antibiotics are deemed necessary.
authors.affiliation: Dept of Medicine, University Health Network, Mount Sinai Hospital, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Leber
authors.forename: T K
authors.initials: TK
authors.lastname: Marras
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D017563:Lung Diseases, Interstitial / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D009864:Ontario; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents