Economic impact of elexacaftor/tezacaftor/ivacaftor on healthcare expenditure in Canada.

The introduction of elexacaftor/tezacaftor/ivacaftor (ETI) has led to improved outcomes and survival in patients living with cystic fibrosis (PwCF) although imposes a substantial economic burden. Despite the reduced healthcare utilization that follows ETI initiation, the economic impact on healthcare spending is not well understood. To try and better understand this, the estimated economic impact on healthcare spending of ETI was calculated in Canada. A treatment naïve cohort of PwCF receiving their first ETI prescription during the 2021-2022 fiscal year from 7 provinces had their healthcare utilization and costs collected one year prior and one year following the initiation of ETI for each patient. Data available included physician visits, emergency department presentations, hospitalizations, drug utilization and laboratory and other diagnostic charges. In the year prior to the first ETI prescription, there was an estimated direct health care cost of $17.6 million CDN. The spending decreased significantly in the year post ETI by $6.9 million with the majority attributed to a 75% reduction in hospitalization-associated costs. When the list price of ETI is accounted for, up to an additional $203 million was spent in the first year after ETI. Irrespective of improvements in life quality brought about by ETI, a price of approximately $10,000/year would be required for it to be cost neutral.