Changes in Health-Related Quality of Life According to Treatment Course in Patients With Nontuberculous Mycobacterial Pulmonary Disease

Abstract Background: Nontuberculous mycobacterial pulmonary disease (NTM-PD) shows various disease courses, while microbiological cure rates are not high. Aside from its symptoms and the progression of the disease, the treatment itself and the side effects of the drug may impact the patients’ health-related quality of life (HRQoL). This study assesses changes in health status in NTM-PD patients with different treatment courses by utilizing the EQ-5D-5L within the nationwide NTM-KOREA cohort. Methods: For individuals who completed the EQ-5D-5L survey more than twice since baseline, participants were divided into three groups based on culture conversion status and treatment completion: one group that experienced culture conversion, a second group that continued treatment but failed to achieve culture conversion, and a third group with early treatment termination. The results from four surveys conducted at six-month intervals were used to assess the quality-adjusted life year (QALY) values derived from HRQoL, represented by QALY weights. Results: Among the 327 patients analyzed, 256 patients (78.3%) reported to have Mycobacterium avium complex as main pathogen, and Mycobacterium abscessus subspecies abscessus were isolated in 40 patients (12.2%), while 29 patients (8.9%) had Mycobacterium abscessus subspecies massiliense isolates. Total 134 (41.0%) achieved culture conversion with treatment completion, whereas 101 patients (30.9%) interrupted their treatment early. Each group showed a significant difference in treatment duration (mean 413±125, 365±188, 261±173 days for culture conversion positive, conversion negative, treatment interrupted group, respectively, with p<0.001). When calculating average QALY weight throughout the follow up period, the treatment interruption group had an average value of 0.845±0.114, compared to 0.864±0.104 and 0.864±0.126 for the group that continued treatment with or without culture conversion, indicating a measurable distinction between the groups (p=0.010). Given that the follow-up duration varied between the groups (mean 514±133, 495±114, 496±126 days for culture conversion positive, conversion negative, treatment interrupted group, respectively, with p=0.013), the QALY values for each group also showed notable differences. The QALY was calculated at 1.217±0.353 years for the culture conversion achieved group, 1.169±0.314 years for the culture conversion failed with treatment maintenance group, and 1.139±0.304 years for the treatment interrupted group (p<0.001). Conclusion: QALY gain was observed in the ongoing treatment groups compared to the group that interrupted treatment early, suggesting that maintaining treatment for NTM-PD may be beneficial even if culture conversion is not achieved.