Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial. Issue 7 (5th April 2016) - Beerthuizen, Thijs
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).