Cost-Effectiveness Analysis of Monitoring Fractional Exhaled Nitric Oxide (FeNO) in the Management of Asthma.

ABSTRACT

PURPOSE: Current asthma guidelines combine treatment, follow-up, and reevaluation to manage asthma control, reduce impairment, and decrease risk of morbidity in patients. Clinical use of biomarkers, such as fractional exhaled nitric oxide (FeNO), along with standard management can provide clinicians with improved ability to recognize airway inflammation, optimize drug therapy, and potentially increase asthma control. Our objective is to examine the impact of FeNO monitoring on the cost effectiveness of asthma management compared with management without FeNO. Sensitivity analyses further examine the impact of FeNO monitoring on patients with varying levels of severity and exacerbations. DESIGN AND METHODS: A decision-tree analysis of estimated outcomes and costs associated with annual management of asthma was utilized to simulate asthma management and treatment cost scenarios, comparing estimated 12-month costs and outcomes using the following treatment alternatives (1) current standard of care (SOC) or (2) FeNO utilized in conjunction with the current SOC. Costs were estimated from the perspective of the health care payer; cost effectiveness was estimated as cost per quality-adjusted life year (QALY). RESULTS: FeNO in conjunction with SOC guidelines has decreased expected per-patient annual expenditure ($2,228) and increased expected per-patient annual QALYs (0.844) compared with SOC alone ($2,637 and 0.767). FeNO monitoring with SOC resulted in decreased annual costs and increased annual QALYs compared with SOC alone, and this difference was consistent through all one-way sensitivity analyses. CONCLUSION: Our analysis revealed that FeNO monitoring to guide asthma management is cost effective and could result in increased QALYs and decreased health care costs associated with asthma management.