Cost Analysis of FeNO-based Asthma Management in Primary Care in Germany

Background Measurement of the biomarker FeNO (fractional exhaled nitric oxide) provides information on the degree of airway inflammation and thus can be used to support asthma diagnosis and therapy management. Recently the use of FeNO measurement in asthma management is increasingly being taken into account in national and international guidelines. In Germany, FeNO testing is not yet reimbursed by the statutory health insurance (SHI), but endorsed in the national asthma guideline.

Aim To investigate the influence of FeNO-assisted therapy on the quality of care and costs of asthma therapy in primary care from the SHI perspective.

Methods For the evaluation of FeNO in primary care from a SHI perspective, two therapeutic approaches were compared by modelling exacerbations and expected costs with a decision tree analysis. The standard strategy approach was medical care according to the current German guidelines, whereas the FeNO-strategy included an additional FeNO test at each regular appointment for therapy review (once per quarter). The probabilities from studies and secondary data from SHIʼs were included and supplemented by expert opinions on the underlying assumptions for asthma care in Germany. Performed sensitivity analyses underlined the results.

Results A base case was assumed for the calculation of costs for the SHI, in which 90% of the patients are managed by a general practitioner and 10% by a specialist. Furthermore, the case assumed adult patients with allergic asthma under therapy with steroids and a reimbursement of FeNO testing at 21,17 Euro per test. Regarding the quality of asthma care a reduction of exacerbations by 43% and reduction of ICS therapy of 40% compared to the current guideline-based treatment have been considered. The resulting direct care costs for standard and FeNO-strategy were 571,56 Euro and 522,93 Euro per patient per year, respectively.

Conclusion FeNO-based asthma therapy management is superior in terms of quality of care and expected costs. Sensitivity analyses show the robustness of the result, whereby the FeNO-strategy is superior under the preconditions of an ICS reduction of at least 25% in the FeNO-strategy and up to a maximum price of 33,33 Euro per FeNO test.