Predictors of latent tuberculosis infection treatment completion in the US private sector: an analysis of administrative claims data

Abstract

BackgroundFactors that affect latent tuberculosis infection (LTBI) treatment completion in the US have not been well studied beyond public health settings. This gap was highlighted by recent health insurance-related regulatory changes that are likely to increase LTBI treatment by private sector healthcare providers. We analyzed LTBI treatment completion in the private healthcare setting to facilitate planning around this important opportunity for tuberculosis (TB) control in the US.MethodsWe analyzed a national sample of commercial insurance medical and pharmacy claims data for people ages 0 to 64 years who initiated daily dose isoniazid treatment between July 2011 and March 2014 and who had complete data. All individuals resided in the US. Factors associated with treatment completion were examined using multivariable generalized ordered logit models and bivariate Kruskal-Wallis tests or Spearman correlations.ResultsWe identified 1072 individuals with complete data who initiated isoniazid LTBI treatment. Treatment completion was significantly associated with less restrictive health insurance, age < 15 years, patient location, use of interferon-gamma release assays, non-poverty, HIV diagnosis, immunosuppressive drug therapy, and higher cumulative counts of clinical risk factors.ConclusionsPrivate sector healthcare claims data provide insights into LTBI treatment completion patterns and patient/provider behaviors. Such information is critical to understanding the opportunities and limitations of private healthcare in the US to support treatment completion as this sector’s role in protecting against and eliminating TB grows.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5578-3) contains supplementary material, which is available to authorized users.

Addressing Latent Tuberculosis Infection Treatment Through a Collaborative Care Model With Community Pharmacies and a Health Department

“…ADEs, including nausea/vomiting and fatigue, were associated with noncompletion of LTBI treatment in this study. This finding is also consistent with prior studies (18,21). Most potential medication side effects reported with 3HP were not serious and may have been due to other causes.…”

“…Completion rates for LTBI vary considerably in the literature, ranging from 35%-90%, with higher completion rates generally reported with shorter treatment regimens (10,(12)(13)(14)(15)(16)(17). Predictors for noncompletion include unstable housing, tobacco use, alcohol use, adverse drug events (ADEs), older age, patient location, poverty, and non-Hispanic ethnicity (14,(18)(19)(20)(21).…”

Factores asociados al cumplimiento de la terapia preventiva con isoniacida en niños en Quito, Ecuador (2014-2016 y 2018)

“…En Estados Unidos de América, se realizó un estudio para evaluar predictores de cumplimiento, con una tasa de 46,2%, menor que la mostrada en este estudio; para ello tomaron personas de todas las edades, sin encontrar diferencias por sexo (16). Otro estudio realizado en Noruega en 2016 incluyó el total de pacientes notificados con inicio de tratamiento (n = 726), de las cuales 62 eran menores de 5 años.…”

Interferon gamma release assay tests are associated with persistence and completion of latent tuberculosis infection treatment in the United States: Evidence from commercial insurance data

“…While we are unable to make causal statements based on our data, our findings suggest that IGRAs may also promote LTBI treatment persistence and completion. Past studies examining the differences in treatment completion for patients receiving IGRAs or TSTs have had varied results, with many finding no difference and only a couple identifying significant differences [20,21,[25][26][27][28]. However, unlike almost all prior studies, we examined data from the private healthcare sector.…”

“…Available reports of association between LTBI testing method and treatment completion provide inconclusive and mixed evidence, four finding no significant difference in treatment completion rates by diagnostic method and two reporting an association between higher completion rates and diagnosis using IGRA [20,21,[25][26][27][28]. All but one of these studies focused on safety net or other public programs [25] and may not be generalizable to the private healthcare sector setting. Further, serial testing is not uncommon and may affect completion rates, but the single private system completion study categorized patients based only on the first test received and did not evaluate serial testing [25].…”