Tobramycin Powder for Inhalation for the Treatment of Cystic Fibrosis: Analysis of the RAMQ Data


      To describe treatment patterns and measure real-world outcomes with tobramycin powder for inhalation (TIP), tobramycin inhalation solution (TIS), and other tobramycin formulations (OTF), using the provincial public drug reimbursement program database of the Régie de l’assurance maladie du Québec(RAMQ).


      Patients with a diagnosis of CF covered by the RAMQ drug reimbursement program who had used TIP, TIS, or OTF on at least one occasion during the period from January 1st 2011 to June 30th 2012 were selected. Patient’s characteristics, drug utilization patterns and resource utilization were analyzed.


      Data were available for a sample of 244 eligible patients. The average age of the study population was 24.3 years (SD=12.5). While the maximum medication possession ratio (MPR) for alternate month administration is 50%, patients on TIP had an average MPR of 52.8%, while patients on TIS and OTF had an average MPR of 41.4% and 39.7%, respectively. Treatment persistence at 3 months was estimated at 85.5%, 69.0%, and 65.2% for patients on TIP, TIS, and OTF, respectively. Treatment persistence at 6 months was estimated at 78.4%, 62.8%, and 56.5%, respectively for patients on TIP, TIS, and OTF. Higher CF medication treatment costs with TIP were partially offset by lower costs associated with the use of antibiotics, other medications and additional health care resource utilization. The median monthly cost per patient in terms of other medications was of $1,159 (including $79 for other antibiotics), $1,350 ($172), and $1,495 ($240) for patients on TIP, TIS, and OTF, respectively. The median monthly additional health care resource utilization cost per patient was estimated at $56, $188, and $220, respectively for TIP, TIS and OTF cohorts.


      In a real life setting, TIP was associated with a high level of treatment adherence and limited utilization of additional health care resources.