Brooks Elizabeth A, Massanari Marc
Decision Driver Analytics, Asheville, N.C.
Circassia Pharmaceuticals, Morrisville, N.C.
Manag Care. 2018 Jul;27(7):42-48.
Current asthma guidelines combine treatment, follow-up, and reevaluation to manage asthma control, reduce impairment, and decrease risk of morbidity in patients. Clinical use of biomarkers, such as fractional exhaled nitric oxide (FeNO), along with standard management can provide clinicians with improved ability to recognize airway inflammation, optimize drug therapy, and potentially increase asthma control. Our objective is to examine the impact of FeNO monitoring on the cost effectiveness of asthma management compared with management without FeNO. Sensitivity analyses further examine the impact of FeNO monitoring on patients with varying levels of severity and exacerbations.
A decision-tree analysis of estimated outcomes and costs associated with annual management of asthma was utilized to simulate asthma management and treatment cost scenarios, comparing estimated 12-month costs and outcomes using the following treatment alternatives: (1) current standard of care (SOC) or (2) FeNO utilized in conjunction with the current SOC. Costs were estimated from the perspective of the health care payer; cost effectiveness was estimated as cost per quality-adjusted life year (QALY).
FeNO in conjunction with SOC guidelines has decreased expected per-patient annual expenditure ($2,228) and increased expected per-patient annual QALYs (0.844) compared with SOC alone ($2,637 and 0.767). FeNO monitoring with SOC resulted in decreased annual costs and increased annual QALYs compared with SOC alone, and this difference was consistent through all one-way sensitivity analyses.
Our analysis revealed that FeNO monitoring to guide asthma management is cost effective and could result in increased QALYs and decreased health care costs associated with asthma management.
当前哮喘指南将治疗、随访和重新评估相结合，以管理哮喘控制情况，减少损害，并降低患者发病风险。使用生物标志物，如呼出一氧化氮分数（FeNO），并结合标准管理方法，可为临床医生提供更强的能力来识别气道炎症、优化药物治疗，并有可能提高哮喘控制水平。我们的目标是研究与不使用FeNO的管理方法相比，FeNO监测对哮喘管理成本效益的影响。敏感性分析进一步研究了FeNO监测对不同严重程度和发作次数患者的影响。
利用决策树分析估计与哮喘年度管理相关的结果和成本，以模拟哮喘管理和治疗成本情景，使用以下治疗方案比较估计的12个月成本和结果：（1）当前的标准治疗（SOC）或（2）与当前SOC联合使用的FeNO。成本从医疗保健支付方的角度进行估计；成本效益以每质量调整生命年（QALY）的成本来估计。
与单独使用SOC（2637美元和0.767）相比，FeNO与SOC指南联合使用可降低预期的每位患者年度支出（2228美元），并增加预期的每位患者年度QALY（0.844）。与单独使用SOC相比，FeNO与SOC联合监测可降低年度成本并增加年度QALY，并且在所有单向敏感性分析中这种差异都是一致的。
我们的分析表明，使用FeNO监测来指导哮喘管理具有成本效益，并且可能会增加QALY，并降低与哮喘管理相关的医疗保健成本。
