Comparative Cost Analysis of Monitoring Exhaled Nitric Oxide (FeNO) in Asthma Management

Asthma guidelines recommend periodic assessment and management of symptoms to prevent exacerbations, which can lead to hospitalization, increased healthcare utilization and cost. According to recent Cochrane meta-analysis data, FeNO monitoring is associated with a 40-50% reduction in the risk of exacerbations. Cost modelling of these data indicated the potential for significant cost savings with FeNO use. Therefore we attempted to verify this potential for cost savings within a real-world database of Medicare recipients. This retrospective observational study investigated asthma-related claims from a Medicare database. Patients were included that had 2 years of records following an asthma-related inpatient hospitalization (IP) or emergency department (ED) claim and had a history of an asthma-related event in the prior year. A case-crossover analysis was completed of asthma-related IP/ED events before and after FeNO use during the two-year study period. 63 patients of the 2,828 asthma patients who met the inclusion criteria within the database had a FeNO test during the two-year study period. During the period before FeNO use, 61/63 (97%) patients had an asthma-related IP/ED event compared to 30/63 (48%) during the FeNO period. Asthma-related IP/ED claims and charges per patient per day during the period before FeNO were 0.026 and $12,368 compared to 0.003 and $1,340 during the FeNO period (p< 0.018/0.0043), respectively. FeNO monitoring in patients with a history of exacerbations was associated with a substantial reduction in asthma-related IP/ED claims and charges. These data support cost modelling estimates and demonstrates FeNO use in asthma management is cost-effective.