OBJECTIVES:

Asthma is a chronic respiratory disease that affects over 260 million people and causes more than 460000 deaths. To date, asthma cannot be cured, but its symptoms can be controlled. In this context, fractional exhaled nitric oxide (FeNO) testing is essential to assess type 2 inflammation and therefore improve asthma management, determine eligibility for a specific biologic therapy and predict likelihood to respond. The aim of this study was to estimate the overall economic impact of an extensive use of FeNO testing on the Italian population with asthma, including extra costs of testing and savings generated by more appropriate prescriptions, increased adherence and lower frequency of exacerbations.

METHODS:

A cost of illness analysis was firstly performed to estimate the yearly economic burden from the National Healthcare Service (NHS) perspective in Italy of the management of asthmatic patients with standard of care (SOC) according to the application of GINA (Global Initiative for Asthma) guidelines; secondly, we evaluated the changes in the economic burden in patient management by introducing FeNO testing into clinical practice. The cost items considered were: visits/exams, exacerbations, drugs, management of adverse events caused by short-term oral corticosteroids use. Efficacy of FeNO test and SOC comes from published literature. Costs refers to published data or DRG/outpatient tariffs.

RESULTS:

Considering one pneumological visit every 3 months, the total yearly cost for the management of patients with asthma in Italy is 1,593,275,629€ (407.55€ per patient), while for FeNO testing strategy this figure is 1,389,087,500€ (355.32€ per patient). An increased utilization rate of FeNO testing from 50% to 100% of patients may lead to savings for the NHS from about 102 to 204 million € compared to SOC.

CONCLUSIONS:

Our study showed that FeNO testing strategy may improve the management of asthmatic patients leading to possible savings for the NHS.