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



Keogh, Ruth H, Cosgriff, Rebecca, Andrinopoulou, Eleni-Rosalina, Brownlee, Keith G, Carr, Siobhan B, Diaz-Ordaz, Karla, Granger, Emily, Jewell, Nicholas P, Lewin, Alex, Leyrat, Clemence
et al (show 4 more authors) (2022) 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. THORAX, 77 (9). pp. 873-881.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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 FEV<sub>1</sub>% and approach 2 based on effect estimates on exacerbation rate.<h4>Results</h4>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.<h4>Conclusions</h4>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.

Item Type: Article
Uncontrolled Keywords: Humans, Cystic Fibrosis, Aminophenols, Cystic Fibrosis Transmembrane Conductance Regulator, Anti-Bacterial Agents, Registries, Mutation, Benzodioxoles, Randomized Controlled Trials as Topic, Observational Studies as Topic
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 27 Sep 2021 08:10
Last Modified: 08 Feb 2023 02:19
DOI: 10.1136/thoraxjnl-2020-216265
Open Access URL: https://thorax.bmj.com/content/early/2021/09/23/th...
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3138442