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

Document Type : Original Article


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


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.

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.

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.

Implementing the cost-exemption policy effectively reduced the treatment interruption rate among patients with DS pulmonary TB.


Articles in Press, Corrected Proof
Available Online from 10 June 2024
  • Receive Date: 29 August 2023
  • Revise Date: 25 May 2024
  • Accept Date: 08 June 2024
  • First Publish Date: 10 June 2024