FeNO Suppression Testing Cost Effective for Detecting Nonadherence in Difficult-to-Control Asthma

Fractional exhaled nitric oxide (FeNO) suppression testing (FeNOSuppT) is likely to be cost effective as a protocol-driven, objective, biomarker-based nonadherence screening tool before the initiation of biologic therapy in patients with difficult-to-control asthma, according to a study published online in The Journal of Allergy and Clinical Immunology: In Practice.

“This cost effectiveness is driven by cost savings from patients not progressing to expensive biologic therapy,” wrote corresponding author Liam G. Heaney, MD, of Queens University Belfast in the United Kingdom, and study coauthors.

To gauge cost effectiveness, researchers used a decision-tree model that simulated the progression of a cohort of US adults with difficult-to-control asthma and high FeNO levels (at or above 45 parts per billion) over 1 year. Two strategies, with and without FeNOSuppT, were included.

Per patient, FeNOSuppT prior to biologic therapy was associated with $4435 in lower costs and 0.0023 fewer quality-adjusted life years compared with no FeNOSuppT over 1 year in the baseline scenario, according to the study. With an incremental net monetary benefit of $4207, estimated using a discount rate of 3% and a willingness-to-pay threshold of $100,000 per quality-adjusted life year, FeNOSuppT was considered cost effective.

FeNOSuppT was consistently cost effective across a range of scenarios and sensitivity analyses, researchers added. As an additional screening step, FeNOSuppT was associated with budget savings ranging from $5 million for a low-uptake scenario of 20% over 1 year to $27 million for a 100% uptake scenario.

“Global Initiative for Asthma guidelines emphasize the need to identify nonadherence to inhaled corticosteroids, and our data support wider implementation of FeNOSuppT in difficult-to-control asthma, prior to escalation to biologic therapy, because it is both clinically and cost-effective,” researchers wrote.

Reference

Barry LE, O'Neill C, Butler C, Chaudhuri R, Heaney LG. Cost-effectiveness of fractional exhaled nitric oxide suppression testing as an adherence screening tool among patients with difficult-to-control asthma. J Allergy Clin Immunol Pract. 2023;11(6):1796-1804.e3. doi:10.1016/j.jaip.2023.03.008