Cost-effectiveness of FeNO- and web-based monitoring in pediatric asthma management

Abstract

Background: In children with asthma, web-based and inflammation-driven monitoring might lead to improved asthma control and reduction in medication 1 . Objective: To assess the cost-effectiveness of web-based monitoring with the Asthma Control Test (ACT) and of monitoring with fractional exhaled nitric oxide (FeNO), as compared to standard care. Methods: An economic evaluation was performed alongside a randomized controlled trial with a 1-year follow up. 272 asthmatic children (4-18 yrs) were randomized to 1 of 3 strategies. Treatment was adapted in the web group according to ACT obtained via a website at 1 months intervals; in the FeNO group according to ACT and FeNO, and in the standard care group according to the ACT, at 4-monthly clinic visits. Outcomes were patient utilities, healthcare costs, societal costs and incremental cost per quality adjusted life year(QALY) gained. Results: No significant differences were found in QALY9s and costs between the 3 strategies. The web-based strategy had 80% chance of being most cost-effective from a health care perspective at a willingness to pay of €40.000/QALY. The FeNO-based strategy had 68% chance of being most cost-effective at €40.000/QALY from a societal perspective. Conclusion: Economically, web-based monitoring and FeNO monitoring were as cost-effective as standard care. No significant changes were found in QALY9s and costs. From a health care perspective the web-based strategy was preferred, whilst the FeNO-based strategy was preferred from a societal perspective. Both web-based and FeNO-based strategies may be useful additions to standard care. 1.Voorend-van Bergen S. Monitoring in children with asthma: a randomised controlled trial. Thorax 2015, in press.