(325) Impact of elexacaftor/tezacaftor/ivacaftor on hospital healthcare resource utilization in cystic fibrosis: Danish nationwide register study

Background: Elexacaftor/tezacaftor/ivacaftor (ETI) has changed the lives of people living with cystic fibrosis (CF) by demonstrating clinical effects on several pulmonary and extrapulmonary outcomes. However, less is known about the real-world impact that ETI has had on healthcare resource utilization.

Objectives: This study aimed to evaluate the effectiveness of ETI on hospital healthcare resource utilization in a Danish CF cohort.

Methods: This self-controlled cohort study included all individuals aged >12 years who initiated ETI between 2018 and 2022 in Denmark and were included in the Danish CF Registry. Acute and elective, inpatient and outpatient hospital encounters were analyzed pre- and post-ETI initiation via data linkage to the National Patient Registry. Outcomes were categorized monthly, as zero versus at least one hospital encounter. The impact of ETI on hospitalization was assessed by calculating the odds ratio (OR) using Generalized Estimating Equations logistic regression to account for correlated outcome data within each individual. The model was adjusted for seasonality and COVID-19. COVID-19 was included as a time dependent binary variable indicating national lockdown or not.

Results: A total of 283 individuals initiated ETI, of whom 49.1% were female and 75.6% were F508del homozygous. The median age at ETI initiation was 26 years (IQR: 18-35).
For all outpatient and inpatient contacts, the adjusted odds ratios (ORs) for having at least one monthly hospital encounter were reduced 6 months after ETI initiation compared to the 24 months prior. Specifically, the OR for acute inpatient contacts was 0.38 (95% CI: 0.21-0.69), for elective inpatient contacts 0.37 (95% CI: 0.23-0.61), for acute outpatient contacts 0.64 (95% CI: 0.41-0.98), and for elective outpatient contacts 0.76 (95% CI: 0.66-0.87).
At 24 months post-ETI initiation, the odds of any monthly hospital encounter were further reduced for elective hospital contacts. The OR for elective inpatient contacts was 0.20 (95% CI: 0.08-0.50) and for elective outpatient contacts 0.70 (95% CI: 0.57-0.86). However, there was no longer a significant reduction in acute inpatient contacts (OR: 0.69 (95% CI: 0.34-1.40)) or acute outpatient contacts (OR: 0.89 (95% CI: 0.50-1.57)).

Conclusions: In a national cohort of people living with CF, the probability of elective inpatient and outpatient hospital contacts was significantly reduced over the two years following ETI initiation. While the utilization of acute hospital contacts showed an initial reduction, it returned to pre-ETI levels thereafter. These findings highlight the real-world impact of ETI on healthcare utilization which is crucial for patients, caregivers, clinicians, and healthcare planners, given the significant burden that hospitalizations impose on all stakeholders involved.