International Journal of Health Policy and Management

International Journal of Health Policy and Management

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

Document Type : Original Article

Authors
Sang Chul Lee 1
Jae Kwang Lee 2
Hyun Woo Ji 1
Jung Mo Lee 1
Seon Cheol Park 1
Chang Hoon Han 1
1 Division of Pulmonology and Clinical Allergy, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
2 Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
10.34172/ijhpm.8262
Abstract
Background 
In 2021, South Korea had the highest incidence rate (49 per 100 000 population) and the third highest mortality rate (3.8 per 100 000 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 2013 to 2019 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, 73 116 and 1673 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: −0.097, P = .011). However, it increased in the intensive phase in the MDR-TB group (slope change: 0.733, P = .001). MDR-TB patients were likely to experience an interruption of TB treatment (adjusted odds ratio [aOR], 6.04; 95% CI, 5.43–6.71), and treatment interruption history was a significant risk factor for 1-year and overall mortality rates (adjusted hazard ratios [aHRs]: 2.01, 95% CI, 1.86–2.18 and 1.77, 95% CI, 1.70–1.84, 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
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International Journal of Health Policy and Management
Volume 13, Issue 1
2024
Pages 1-9

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  • Received Date 29 August 2023
  • Revised Date 25 May 2024
  • Accepted Date 08 June 2024
  • First Published Date 10 June 2024
  • Published Date 01 December 2024