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

Introduction 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 ICD-10 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) three years before and after the diagnosis. Annual costs were estimated using a generalised linear model with 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 €24 454 (95% CI: €22 378–€26 723) for patients versus €4233 (95% CI: €4057–€4417) for comparators. Employment income declined before diagnosis and remained significantly lower (€9547 versus €18 720), while public benefit payments were higher (€18 005 versus €8978). Net costs peaked at €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 fivefold higher direct healthcare costs, reduced income, increased public benefit payments, and with net costs exceeding €29 000 in the diagnosis year.