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Cost impact of monitoring exhaled nitric oxide in asthma management

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Background:

Asthma guidelines recommend periodic assessment of impairment and risk factors to prevent exacerbations, which can lead to hospitalization and increased health care utilization and cost. According to recent meta-analysis data, fractional exhaled nitric oxide (FeNO) monitoring is associated with a 40‐50% reduction in the risk of exacerbations.

Objective:

Cost modeling of these data indicates the potential for significant cost savings with FeNO use. Therefore, we attempted to verify this potential for cost savings within a real-world data base of Medicare beneficiaries.

Methods:

This retrospective observational study investigated asthma-related claims from a Medicare data base. Beneficiaries were included who had 2 years of records after an asthma-related inpatient hospitalization (IP) or emergency department (ED) claim. A case-crossover analysis was completed of asthma-related IP or ED events before and after FeNO use during the 2-year study period.

Results:

Of the 5911 asthma beneficiaries who met the inclusion criteria within the data base, 101 had an FeNO test during the 2-year study period. During the period before FeNO use, 98 of 101 (97%) beneficiaries had an asthma-related IP or ED event compared with 46 of 101 (46%) during the FeNO period. Asthma-related IP or ED claims and charges per beneficiary per day during the period before FeNO were 0.004 and $16.21 compared with 0.002 and $6.46 during the FeNO period (p = 0.0433 and p = 0.0133, respectively).

Conclusion:

FeNO monitoring in beneficiaries with a history of exacerbations was associated with a substantial reduction in asthma-related IP and ED claims and charges. These data supported cost modeling estimates and demonstrated that FeNO use in asthma management was associated with significant cost savings.

Keywords: FeNO; airway inflammation; asthma exacerbations; asthma monitoring; biomarkers; nitric oxide

Document Type: Research Article

Affiliations: 1: From Health Economics and Outcomes Research, Navigant Consulting, Inc., New York, New York and San Francisco, California 2: Global Medical Affairs, Circassia Pharmaceuticals, Inc., Morrisville, North Carolina

Publication date: September 1, 2018

This article was made available online on August 13, 2018 as a Fast Track article with title: "Cost impact of monitoring exhaled nitric oxide in asthma management".

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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