Effect of Cost-Exemption Policy on Treatment Interruption in Patients With Newly Diagnosed Pulmonary Tuberculosis in South Korea

Background In ۲۰۲۱, South Korea had the highest incidence rate (۴۹ per ۱۰۰ ۰۰۰ population) and the third highest mortality rate (۳.۸ per ۱۰۰ ۰۰۰ population) due to pulmonary tuberculosis (TB) among Organization for Economic Co-operation and Development countries. Notably, premature interruption of TB treatment interferes with TB control efforts. Therefore, we examined the effect of the co-payment waiver on treatment interruption and mortality among patients with pulmonary TB in South Korea.Methods Patients who had newly treated TB in South Korea from ۲۰۱۳ to ۲۰۱۹ were selected from the nationwide data of the entire Korean National Health Insurance Service (NHIS) population. The effects of policy implementation on treatment adherence and mortality rates depending on treatment interruption history were evaluated.Results In total, ۷۳ ۱۱۶ and ۱۶۷۳ patients with drug-susceptible (DS) and multidrug-resistant (MDR) pulmonary TB, respectively, were included in the final study population. After implementing the cost-exemption policy, the treatment interruption rate tended to decrease in the continuation phase in the DS-TB group (slope change: −۰.۰۹۷, P = .۰۱۱). However, it increased in the intensive phase in the MDR-TB group (slope change: ۰.۷۳۳, P = .۰۰۱). MDR-TB patients were likely to experience an interruption of TB treatment (adjusted odds ratio [aOR], ۶.۰۴; ۹۵% CI, ۵.۴۳–۶.۷۱), and treatment interruption history was a significant risk factor for ۱-year and overall mortality rates (adjusted hazard ratios [aHRs]: ۲.۰۱, ۹۵% CI, ۱.۸۶–۲.۱۸ and ۱.۷۷, ۹۵% CI, ۱.۷۰–۱.۸۴, respectively) in the DS-TB group.Conclusion Implementing the cost-exemption policy effectively reduced the treatment interruption rate among patients with DS pulmonary TB.

Keywords:

Tuberculosis , Compliance , Mortality , Risk Factors , Administrative Data , Korea