Projecting the impact of triple CFTR modulator therapy on intravenous antibiotic requirements in cystic fibrosis using patient registry data combined with treatment effects from randomised trials

Ruth H. Keogh*, Rebecca Cosgriff, Eleni Rosalina Andrinopoulou, Keith G. Brownlee, Siobhán B. Carr, Karla Diaz-Ordaz, Emily Granger, Nicholas P. Jewell, Alex Lewin, Clemence Leyrat, Daniela K. Schlüter, Maarten van Smeden, Rhonda D. Szczesniak, Gary J. Connett

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Downloads (Pure)

Abstract

BACKGROUND: Cystic fibrosis (CF) is a life-threatening genetic disease, affecting around 10 500 people in the UK. Precision medicines have been developed to treat specific CF-gene mutations. The newest, elexacaftor/tezacaftor/ivacaftor (ELEX/TEZ/IVA), has been found to be highly effective in randomised controlled trials (RCTs) and became available to a large proportion of UK CF patients in 2020. Understanding the potential health economic impacts of ELEX/TEZ/IVA is vital to planning service provision. METHODS: We combined observational UK CF Registry data with RCT results to project the impact of ELEX/TEZ/IVA on total days of intravenous (IV) antibiotic treatment at a population level. Registry data from 2015 to 2017 were used to develop prediction models for IV days over a 1-year period using several predictors, and to estimate 1-year population total IV days based on standards of care pre-ELEX/TEZ/IVA. We considered two approaches to imposing the impact of ELEX/TEZ/IVA on projected outcomes using effect estimates from RCTs: approach 1 based on effect estimates on FEV1% and approach 2 based on effect estimates on exacerbation rate. RESULTS: ELEX/TEZ/IVA is expected to result in significant reductions in population-level requirements for IV antibiotics of 16.1% (~17 800 days) using approach 1 and 43.6% (~39 500 days) using approach 2. The two approaches require different assumptions. Increased understanding of the mechanisms through which ELEX/TEZ/IVA acts on these outcomes would enable further refinements to our projections. CONCLUSIONS: This work contributes to increased understanding of the changing healthcare needs of people with CF and illustrates how Registry data can be used in combination with RCT evidence to estimate population-level treatment impacts.

Original languageEnglish
Pages (from-to)873-881
Number of pages9
JournalThorax
Volume77
Issue number9
DOIs
Publication statusPublished - Sep 2022

Bibliographical note

Funding: RHK and EG were supported by a UKRI Future Leaders Fellowship (MR/
S017968/1) awarded to RHK. RDS and E-RA were supported by the National
Institutes of Health/National Heart, Lung and Blood Institute (grant R01 HL141286).
KD-O was supported by a Royal Society Wellcome Trust Sir Henry Dale Fellowship
(218554/Z/19/Z).

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Fingerprint

Dive into the research topics of 'Projecting the impact of triple CFTR modulator therapy on intravenous antibiotic requirements in cystic fibrosis using patient registry data combined with treatment effects from randomised trials'. Together they form a unique fingerprint.

Cite this