The following is a summary of “Cost-Effectiveness of Fractional Exhaled Nitric Oxide Suppression Testing as an Adherence Screening Tool Among Patients With Difficult-to-Control Asthma,” published in the June 2023 issue of Allergy and Clinical Immunology by Barry et al.

Approximately 50% of long-term asthma medication users are non-adherent. Current methods for detecting nonadherence could be more effective. Before initiating costly biologic therapy, fractional exhaled nitric oxide suppression testing (FeNOSuppT) has shown clinical efficacy as an adherence screening instrument to detect poor adherence to inhaled corticosteroids in difficult-to-control asthma. 

This study aims to determine the cost-effectiveness and fiscal impact of FeNOSuppT as a screening test before initiating biologic therapy in U.S. adults with difficult-to-control asthma and high fractional exhaled nitric oxide (≥45 ppb). A decision tree was used to simulate the progression of a cohort of patients over a one-year time horizon into one of three states (discharged from, remaining in specialist care, or progressing to biologics). The incremental net monetary benefit of the two strategies, with and without FeNOSuppT, was estimated using a discount rate of 3% and a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY). In addition, a sensitivity analysis and a budget impact analysis were conducted. 

In the baseline scenario, FeNOSuppT before the initiation of biologic therapy was associated with lower costs ($4,435) and fewer QALYs (0.0023 QALY/patient) than no FeNOSuppT and was deemed cost-effective (incremental net monetary benefit = $4,207). The FeNOSuppT was cost-effective across various scenarios and probabilistic and deterministic sensitivity analyses. Assuming different FeNOSuppT uptake levels (20%–100%) resulted in budgetary savings from $5 million to $27 million. As a protocol-driven, objective, biomarker-based tool for identifying nonadherence in difficult-to-control asthma, the FeNOSuppT will likely be cost-effective. This cost-effectiveness results from the savings realized when patients do not progress to costly biologic therapy.

Source: sciencedirect.com/science/article/pii/S2213219823002921