Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain

Abstract

Objectives: Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. Methods: A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. Results: The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. Conclusions: The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines. Key words: Asthma management. Biomarker. Budget impact. Cost-effectiveness. FeNO. Guidelines. Exhaled nitric oxide. ResumenObjetivos: La fracción exhalada del óxido nítrico (FeNO) es un marcador de la inflamación bronquial de tipo Th-2. El objetivo de este estudio ha sido evaluar el coste-efectividad e impacto presupuestario de la monitorización del FeNO en el manejo del asma del adulto en España. Métodos: Se ha utilizado un modelo de análisis de coste-efectividad para evaluar los resultados económicos cuando se utilizó el FeNO en el manejo del asma durante un año. El modelo estimó el incremento de coste por calidad de vida ajustada por año (QALY) y el número de exacerbaciones evitadas cuando se añadió el FeNO a la guía habitual de tratamiento del asma en comparación con la guía habitual. Se aplicó un análisis univariante y multivariante para valorar la posible incertidumbre del modelo. Se utilizó un modelo de impacto presupuestario para evaluar el impacto económico de la introducción de la monitorización con el FeNO en consultas de atención primaria del estado español y teniendo en cuenta el sistema sanitario español. Resultados: Se ha demostrado que el añadir el FeNO al tratamiento habitual del asma ahorra 62,53€ por paciente por año en adultos con asma y mejoró la QALYs en 0,026 por paciente y año. El análisis económico resultó en un ahorro estimado de 129 millones de euros netos por año en consultas de atención primaria. Conclusiones: El modelo económico utilizado ha mostrado que el añadir el FeNO al algoritmo habitual de tratamiento del asma conlleva a un importante ahorro en recursos económicos y un aumento d...

2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group

“…As a result, disparities in asthma outcomes would widen. Most of the FENO monitoring studies with costeffectiveness data were conducted outside the United States 44,[58][59][60][61] and were therefore of limited value for this update. The Expert Panel recommends cost-effectiveness analyses conducted in the United States.…”

Economic Evaluation of the Use of FeNO for the Diagnosis and Management of Asthma Patients in Primary Care in Sweden

“…However, inclusion of indirect costs would likely improve the results further, since it has been shown that exacerbations lead to several days off work: on average, 3 days for mild exacerbations and 7 days for moderate and severe exacerbations. 27 In the study of Jansson et al, 4 indirect costs, including loss of productivity and absence from work due to sick leave, accounted for the 69% of total reported costs.…”

“…This is the first economic evaluation of the use of FeNO testing in asthma management and diagnosis in Sweden, but some previous economic studies have been carried out in other European countries and in the US, and in all of them FeNO was related to savings and the same or better health outcomes. Sabatelli et al 27 evaluated the cost-effectiveness and budget impact of FeNO monitoring for the management of adult asthma in Spain, with both the cost-effectiveness and budget impact analyses showing savings for the healthcare system when considering the use of FeNO monitoring in primary health care. In other study, Brooks et al 28 examined the impact of FeNO monitoring on the cost-effectiveness of asthma management, with FeNO monitoring being cost effective, and Although this study is similar to the previously conducted economic evaluations described above, it presents some possible limitations.…”

Analysis of the Budget Impact of Fractional Exhaled Nitric Oxide Monitoring in the Management of Childhood Asthma: The Colombian National Health System Perspective

“…For policymakers, the main concerns is the economic impact implicated in adapting this technology, especially in developing countries. Different economic evaluations of the use of FeNO during asthma management in developed countries have demonstrated that FeNO monitoring to guide asthma management was cost-effective [5][6][7][8]. However, costeffectiveness analyses alone do not provide information on the drug's impact on the total healthcare budget, because this is dependent on the number of treated patients .In this paper, we aimed to evaluate the budget impact of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age in Colombia.…”