OBJECTIVES: Describe the cost-effectiveness of utilizing fractional exhaled nitric oxide (FeNO) to inform asthma management in comparison to the standard of care. INTRODUCTION: According to the CDC, in 2014 there were 17.7 million (7.4%) adults and 6.3 million (8.6%) children living with asthma in the US. Asthma guidelines recommend periodic assessment and management of symptoms to prevent exacerbations, the most severe of which can lead to hospitalization, increased healthcare utilization and cost. Some asthmatics have difficulty with achieving disease control, and despite treatment with effective controller agents including inhaled corticosteroids, and sometimes biologics for severe asthma patients, these patients experience an average of 2 exacerbations annually. In addition, according to recent data from Petsky et al. (Cochrane Reviews 2016), when FeNO is incorporated into asthma management, the risk of asthma exacerbations is reduced by 40-50%. METHODS: Using a decision analysis, the short-term cost-effectiveness of two alternatives to asthma management was compared: FeNO measurement in addition to standard of care management and the current standard of care without FeNO measurement. Model assumptions were drawn from the most recent literature pertaining to exacerbation frequency and severity as well as to medication and other medical resource utilization associated with the two asthma management strategies. RESULTS: Annual expected per-patient asthma management costs totaled $2,013 for FeNO plus standard of care, and $2,637 for standard of care alone. The use of FeNO to guide asthma management is expected to result in 0.077 additional QALYs per patient per year, rendering FeNO measurement as an adjunct to standard of care the dominant asthma management strategy. CONCLUSIONS: This cost-effectiveness assessment suggests that widespread inclusion of FeNO measurement for guidance of asthma management would result in reduced risk for exacerbations and overall healthcare cost savings.