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Randomized Controlled Trial
. 2016 Jul;71(7):607-13.
doi: 10.1136/thoraxjnl-2015-207593. Epub 2016 Apr 5.

Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial

Thijs Beerthuizen  1 , Sandra Voorend-van Bergen  2 , Wilbert B van den Hout  1 , Anja A Vaessen-Verberne  3 , Hein J Brackel  4 , Anneke M Landstra  5 , Norbert J van den Berg  6 , Johan C de Jongste  2 , Peter J Merkus  7 , Mariëlle W Pijnenburg  2 , Jacob K Sont  1
Affiliations
Randomized Controlled Trial

Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial

Thijs Beerthuizen et al. Thorax. 2016 Jul.

Abstract

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).

Keywords: Asthma; Health Economist; Paediatric asthma.

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