P216 The impact of the COVID-19 pandemic and elexacaftor/tezacaftor/ivacaftor initiation on high-cost medication utilisation in adults living with cystic fibrosis

The COVID-19 pandemic, lockdowns, and availability of elexacaftor/tezacaftor/ivacaftor (ETI) were significant simultaneous events for people living with cystic fibrosis (pwCF) in the UK. In this study, we aimed to assess the impact of these events on other high-cost medication utilisation. We interrogated the requests for delivery of tobramycin nebuliser solution (TNS), inhaled aztreonam lysine (AZLI), dornase alfa, colomycin and ETI via the homecare service at our large regional adult CF centre. We considered three time periods March 2019-February 2020 (pre-lockdown), March 2020-February 2021 (lockdown) and March 2021 to February 2022 (post-lockdown). Paired t-tests were used to compare requests between time periods. Compared to pre-lockdown, there was a significant increase in requests during lockdown for dornase alfa (mean [SD] 4.0 [1.9] per year to 4.3 [2.3], p = 0.04), but not for TNS (3.4 [2.0] vs. 3.6 [2.7], p = 0.3), AZLI (4.46 [1.8] vs. 4.48 [2.0], p = 0.5) or colomycin (3.6 [1.9] vs. 4.0 [2.7], p = 0.1). However, fewer medication requests were seen post-lockdown compared to lockdown for TNS (3.6 [2.7] vs. 2.7 [2.5], p = 0.002), AZLI 4.5 [2.0] to 3.8 [2.3], p = 0.002), dornase alfa (4.3 [2.3] vs. 3.1 [2.4], p < 0.0001), and colomycin (4.0 [2.7] vs. 2.8 [2.3 per patient], P < 0.0001). Only ETI requests increased during the same time period (7.5 [2.5] per patient vs. 9.3 [2.6] per patient, p < 0.0001). During the COVID-19 pandemic lockdown in the UK, only dornase alfa utilisation increased. However, post lockdown our pwCF are using other high-cost medications less frequently. This may reflect their wish to reduce the CF treatment burden following the introduction of ETI and the improved health this confers. Further work is required to understand the impact, drivers, and influence of reduced utilisation of other medications in pwCF in the post-ETI era.