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Nontuberculous mycobacterial pulmonary disease: a nationwide cost analysis of healthcare costs, foregone earnings and public benefits in a universal healthcare setting

Year: 2025

Type: article

Abstract: Background Nontuberculous mycobacterial pulmonary disease (NTM-PD) is associated with a significant economic burden due to complex diagnostics, prolonged multidrug treatments and hospitalisations. However, cost data are limited, particularly from countries with universal healthcare. We evaluated the economic burden of NTM-PD in Denmark. Methods We conducted a nationwide cost analysis of all adults diagnosed with NTM-PD between 2005 and 2017, identified through International Classification of Diseases, 10th Revision codes. Each case was matched 1:4 to comparators by age, sex, marital/cohabitation status and municipality of residence. We assessed direct healthcare costs (primary and secondary care, and medications) and indirect costs (foregone earnings and public benefits for those aged 18–64 years) 3 years before and after the diagnosis. Annual costs were estimated using a generalised linear model with a gamma distribution and log link. Results We included 545 NTM-PD patients and 2150 comparators. Patients had lower education levels and employment rates. Direct healthcare costs peaked in the diagnosis year at EUR 24 454 (95% CI 22 378–26 723) for patients versus EUR 4233 (95% CI 4057–4417) for comparators. Employment income declined before diagnosis and remained significantly lower (EUR 9547 versus 18 720), while public benefit payments were higher (EUR 18 005 versus 8978). Net costs peaked at EUR 29 394 (95% CI 27 523–31 408) in the diagnosis year, with comorbidity-adjusted direct healthcare costs being 4.8 times higher for patients (p<0.001). Conclusion NTM-PD is associated with a substantial economic burden in Denmark, with nearly 5-fold higher direct healthcare costs, reduced income, increased public benefit payments and with net costs exceeding EUR 29 000 in the diagnosis year.

Source: ERJ Open Research

DOI: 10.1183/23120541.00870-2025

Authors: Victor Naestholt Dahl, Andreas Arnholdt Pedersen, Michael Høffding Ibsen, Ole Hilberg, Anders Løkke, Andreas Fløe