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

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 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.