574. Nontuberculous Mycobacteria Lung Infections: Pre-Index Comorbidity and Utilization Patterns at a Large US Health Plan
Session: Poster Abstract Session: TB: Non-Tuberculous Mycobacterial Infections
Thursday, October 8, 2015
Room: Poster Hall
Background: Nontuberculous mycobacteria (NTM) lung infections are difficult to diagnose since symptoms, such as coughing and fatigue, are common of other respiratory comorbidities. These overlapping symptoms may mask the infection, delaying diagnosis. NTM lung infections are growing among patients over 65 and can exacerbate the deterioration of lung function, compounding respiratory problems for some patients with serious comorbidities. NTM lung infections are challenging to diagnose and treat, which can lead to prolonged treatment with multiple antibiotics. Comorbidities and resource utilization occurring prediagnosis as a function of time vs a matched control group were examined.  

Methods: Using Medicare medical and pharmacy claims between January 1, 2007 and May 31, 2014, NTM lung infection patients (defined by ≥2 separate medical claims for NTM lung infection [ICD-9-CM 031.0]) (n=738) and matched controls (n=5166) were identified; first diagnosis served as the index date. Both groups had ≥18 months of continuous enrollment pre-index. Demographic and treatment characteristics and pre-index utilization patterns were examined. Differences in pre-index comorbidities were generated as odds ratios (OR) by ICD-9-CM chapters.  

Results: Comorbidities analyses showed NTM lung infection patients have significantly higher OR vs controls for 3 ICD-9-CM chapters 3 months prediagnosis: Respiratory System (RR=35.3); Symptoms, Signs, and Ill-defined Conditions (RR=16.3); Infectious and Parasitic Diseases (RR=11.4). Scores are higher as early as 3rd quarter prediagnosis. Pre-index healthcare resource utilization was significantly higher across all categories for NTM lung infection patients vs matched controls (all P<.0001). 

Conclusion: Comorbidity results indicate physicians are applying broad diagnoses in the respiratory, infectious disease and ill-defined condition areas prior to NTM lung infection diagnosis. These patterns are evident ≤9 months prior to diagnosis, suggesting a delay in identifying NTM lung infection and may account for why these patients are utilizing more resources than matched controls during that period. Findings suggest healthcare providers would benefit from better diagnostic tools related to this condition.

Worthe Holt, MD, MMM1, Keli Abraham, PharmD1, Robert Dufour, PhD2, Kevin McDermott, BS3 and Amanda Tarr, PhD2, (1)Humana, Inc., Louisville, KY, (2)Comprehensive Health Insights, Louisville, KY, (3)Insmed Incorporated, Bridgewater, NJ


W. Holt, None

K. Abraham, None

R. Dufour, None

K. McDermott, None

A. Tarr, None

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