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Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled
Thijs Beerthuizen1, Sandra Voorend-van Bergen2, Wilbert B van den Hout1
1Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Web-based asthma monitoring and FENO monitoring offer potential benefits for children, with economic advantages depending on the perspective. These strategies may complement standard care for improved asthma management.
Area of Science:
- Pediatric Pulmonology
- Health Economics
- Clinical Trial Research
Background:
- Web-based monitoring and inflammation-driven therapy show promise for improving asthma control in children.
- The cost-effectiveness of these advanced monitoring strategies remains largely unexplored.
Purpose of the Study:
- To evaluate the cost-effectiveness of web-based monthly monitoring and 4-monthly Fractional Exhaled Nitric Oxide (FENO) monitoring compared to standard asthma care.
- To determine the economic value of different asthma monitoring approaches in pediatric patients.
Main Methods:
- A randomized controlled multicenter trial with 272 children (aged 4-18) with asthma over 1 year.
- Comparison of standard care (Asthma Control Test - ACT), web-based monitoring (web-ACT), and FENO-based monitoring (ACT and FENO).
- Economic evaluation included patient utilities, healthcare costs, societal costs, and incremental cost per Quality-Adjusted Life Year (QALY) gained.
Main Results:
- No statistically significant differences in QALYs or costs were observed between the three monitoring strategies.
- The web-based strategy had a 77% probability of being most cost-effective from a healthcare perspective (€40,000/QALY).
- The FENO-based strategy had an 83% probability of being most cost-effective from a societal perspective (€40,000/QALY).
Conclusions:
- Web-based monitoring is economically favored from a healthcare viewpoint, while FENO-based monitoring is preferred from a societal perspective.
- Despite no significant cost or QALY differences versus standard care, web-based and FENO-based strategies showed favorable clinical outcomes.
- These advanced monitoring strategies may serve as valuable adjuncts to conventional asthma management in children.
Background:
In children with asthma, web-based monitoring and inflammation-driven therapy may lead to improved asthma control and reduction in medications. However, the cost-effectiveness of these monitoring strategies is yet unknown.
Objective:
We assessed the cost-effectiveness of web-based monthly monitoring and of 4-monthly monitoring of FENO as compared with standard care.
Methods:
An economic evaluation was performed alongside a randomised controlled multicentre trial with a 1-year follow-up. Two hundred and seventy-two children with asthma, aged 4-18 years, were randomised to one of three strategies. In standard care, treatment was adapted according to Asthma Control Test (ACT) at 4-monthly visits, in the web-based strategy also according to web-ACT at 1 month intervals, and in the FENO-based strategy according to ACT and FENO at 4-monthly visits. Outcome measures were patient utilities, healthcare costs, societal costs and incremental cost per quality-adjusted life year (QALY) gained.
Results:
No statistically significant differences were found in QALYs and costs between the three strategies. The web-based strategy had 77% chance of being most cost-effective from a healthcare perspective at a willingness to pay a generally accepted €40 000/QALY. The FENO-based strategy had 83% chance of being most cost-effective at €40 000/QALY from a societal perspective.
Conclusions:
Economically, web-based monitoring was preferred from a healthcare perspective, while the FENO-based strategy was preferred from a societal perspective, although in QALYs and costs no statistically significant changes were found as compared with standard care. As clinical outcomes also favoured the web-based and FENO-based strategies, these strategies may be useful additions to standard care.
Trial Registration Number:
Netherlands Trial Register (NTR1995).
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