Abstract
Background: The objective of the study was to describe the epidemiology, management and cost of non-tuberculous mycobacteria lung disease (NTM-PD) in France.Methods: A retrospective analysis was performed using the SNDS database over 2010-2017. Patients with NTM-PD 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 NTM-PD.Results: 5,628 patients with NTM-PD (men: 52.9%, mean age=60.9 years) were identified over the study period and 1,433 (25.5%) were treated with antibiotics. The proportion of patients still receiving treatment at 6 and 12 months was 40% and 22%, respectively.Patients with NTM-PD had more co-morbidities compared to controls: corticoids (57.3% versus 33.8%), chronic lower respiratory disease (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%) (p<0.0001). The mean Charlson comorbidity index score was 1.6 (versus 0.2 for controls; p <0.0001). NTM-PD was independently associated with an increased mortality rate with a hazard ratio of 2.8 (95% CI: 2.53; 3.11). Mortality was lower for patients treated with antibiotics compared to untreated patients (HR=0.772 (95% CI [0.628; 0.949]).Annual total expenses the year following the infection in a societal perspective were € 24,083 (SD: 29,358) in NTM-PD subjects versus € 3,402 (SD: 8,575) in controls (p<0.0001). Main driver of the total expense for NTM-PD patients was hospital expense (>50% of the total expense).Conclusion: Patients with NTM-PD in France were shown to have many comorbidities, their mortality risk is high and mainly driven by NTM-PD, and their management costly. Only a minority of patients got treated with antibiotics and of those patients treated, many stopped their therapy prematurely. These results underline the high burden associated with NTM-PD and the need for improvement of NTM-PD management in France.