How FeNO could offer a cost-effective solution to asthma care

Would you implement a quick and simple test into your asthma care if it helped save money and improve lives? FeNO is here to help. Read on to find out how FeNO testing can aid asthma care, improve patient outcomes, and lead to an increase in cost savings.(1,2)

In the UK, asthma leads to around 60,000 hospital admissions per year and costs ￡6 billion, which includes productivity and quality of life costs.(3,4) Poor asthma control is linked to higher expenses, accounting for up to 75% of all asthma-related costs.(5)

?

How can we improve asthma control?

As poor asthma control accounts for such a large percentage of asthma costs, getting patients asthma under control could help to bring this down.(5,6) Regular in-person asthma assessments, including after an exacerbation, are important to monitor your patient’s asthma, keeping it under control and reducing further risk of exacerbation and hospitalisation.(7,8)

One test you can implement into this assessment to help understand your patients’ asthma control is FeNO testing. FeNO stands for fractional exhaled nitric oxide and offers a way to directly measure the level of Type 2 airway inflammation in a patient’s lungs, associated with the most common type of asthma.(2,9,10)

It is quick to perform, with an actionable measurement given instantly at the point-of-care.9 It can help you to visualise if your patient’s asthma is under control; if they are adherent to medication, on the correct medication, have correct inhaler technique, and predict future exacerbations.(10-13)

FeNO has been shown to be cost effective by identifying non-adherence in patients with difficult-to-control asthma.(6,14) FeNO testing can help reduce the risk of exacerbations by up to 50%, resulting in fewer hospital admissions and costs associated.(15,16)

FeNO is highly sensitive to inhaled corticosteroids, and studies have shown that it can help to titrate dosage, ensuring your patients are on the best-fit medication for them.(12,18) FeNO can also help optimise the use of biological therapies, identifying responders for a “right first time” approach, saving costs of therapies that are unlikely to work.(6)

A report by Asthma and Lung UK, estimated that FeNO testing could lead to savings of ￡147 million, and by improving patent adherence it has been predicted that this could lead to savings of ￡292 million in the UK.(3)

What do these savings look like?

Studies have consistently shown that FeNO leads to cost savings when implemented into asthma care.(6,18-21)

A 2021 study by Buendia et al., looked at the cost savings for management of asthma in children.(21) FeNO-guided asthma management cost $1330 per patient, compared to $1452 with usual care, resulting in a saving of $118 per child and an increase in QALY.(21) These savings are not negligible, considering that asthma affects 10-13% of children. (21)

Another study by Price et al. (2009), determined that asthma management using FeNO measurement instead of lung function testing resulted in annual cost-savings of ￡341 in patients with mild to severe asthma, and savings of ￡554 in patients with moderate to severe asthma. (20)

Overall, implementing FeNO and a wider use of this simple and non-invasive asthma test, could help to reduce costs associated with asthma.(3,20,21) It is important that patients’ asthma remains under control, to allow them to live their lives as symptom-free as possible. The secondary benefit of this is the potential for reduced asthma-associated costs and relieved strain on healthcare resources.(3,4,15,20,21)

Did you know that FeNO testing is covered by QOF (Quality and Outcomes Framework)? Check out our handy QOF calculator to see what your clinic could be compensated for implementing FeNO into your asthma care.

References:

1.??????? Hanania NA et al. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018;120(4):414-418.

2.??????? Loewenthal L et al. FeNO in asthma. Semin Respir Crit Care Med. 2022;43:635-645

3.??????? Asthma and Lung. Investing in Breath: Measuring the economic cost of asthma and COPD in the UK and identifying ways to reduce it through better diagnosis and care. Technical report (2023)

4.??????? National Institute for Health and Care Excellence (NICE). What is the Prevalence of Asthma? Available at: https://cks.nice.org.uk/topics/asthma/background-information/prevalence/. Accessed: July 2024

5.??????? Apter AJ. Enhancing patients adherence to asthma therapy. Up to Date. Last updated; September 2022. Available at; https://www.uptodate.com/contents/enhancing-patient-adherence-to-asthma-therapy.

6.??????? Barry LE et al. Cost-Effectiveness of Fractional Exhaled Nitric Oxide Suppression Testing as an Adherence Screening Tool Among Patients With Difficult-to-Control Asthma. The Journal of Allergy and Clinical Immunology: In Practice. 2023.

7.??????? National Institute for Health and Care Excellence (NICE). Scenario: Follow-up.Available at: https://cks.nice.org.uk/topics/asthma/management/follow-up/. Accessed: July 2024

8.??????? Asthma & Lung UK. What is an asthma review? Availablee at: https://www.asthmaandlung.org.uk/conditions/asthma/manage/asthma-review. Accessed: July 2024.

9.??????? Alving K et al. Validation of a new portable exhaled nitric oxide analyzer, NIOX VERO?: randomized studies in asthma. Pulm Ther. 2017;3:207-218.

10.? Busse W et al. Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. The Lancet Respiratory Medicine. 2021;9(10):1165-73.

11.? Ali H et al. The Potential of Fractional Exhaled Nitric Oxide as a Biomarker in Predicting and Optimizing Use of Treatment in Asthma. South East European Journal of Immunology. 2023;6(1):18-23.

12.? Porsbjerg C et al. Asthma. The Lancet. 2023.

13.? Price DB et al. Fractional exhaled nitric oxide as a predictor of response to inhaled corticosteroids in patients with non-specific respiratory symptoms and insignificant bronchodilator reversibility: a randomised controlled trial. Lancet Respir Med. 2018;6(1):29-39.

14.? Heaney LG et al. Medical Research Council UK Refractory Asthma Stratification Programme (RASP-UK). Remotely monitored therapy and nitric oxide suppression identifies nonadherence in severe asthma. Am J Respir Crit Care Med. 2019;199(4):454-464.

15.? NHS England. Fractional Exhaled Nitric Oxide (FeNO). Available at; https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/rapid-uptake-products/fractional-exhaled-nitric-oxide/. Accessed; July 2024.

16.? Petsky HL et al. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-9.

17.? Louis R et al. European Respiratory Society guidelines for the diagnosis of asthma in adults. European Respiratory Journal. 2022;60(3).

18.? Sabatelli L et al. Cost-effectiveness and budget impact of routine use of fractional exhaled nitric oxide monitoring for the management of adult asthma patients in Spain. J Investig Allergol Clin Immunol. 2017;27(2):89-97.

19.? Brooks EA, Massanari M. Cost-effectiveness analysis of monitoring fractional exhaled nitric oxide (FeNO) in the management of asthma. Manag Care. 2018;27(7):42-48.

20.? Price D et al. An economic evaluation of NIOX MINO airway inflammation monitor in the United Kingdom. Allergy. 2009;64(3):431-8.

21.? Buendía JA, Acu?a-Cordero R, Rodriguez-Martinez CE. Cost utility of fractional exhaled nitric oxide monitoring for the management of children asthma. Cost Effectiveness and Resource Allocation. 2021 Dec 3;19(1):33.

MKT-PRM-UK-0055