Cost-effectiveness of FeNO for diagnosing childhood asthma in primary care (ID 488)
Portsdown Group Practice
Funding: Equipment paid for by Pathway Transformation Funding
Abstract
Background:FeNO testing has been proven to have a role in reducing asthma symptoms and exacerbations and improving condition management, yet there’s still insufficient health-economic data to support FeNO adoption in primary care. Patients and clinicians have relied on guesswork to identify untreated Type 2 inflammation, resulting in inappropriate treatment leading to increased NHS costs.
Objective:
To show that FeNO is cost-effective and can reduce clinical guesswork in children and young people (CYP) with asthma-like symptoms.
Methods:
A short pilot study enrolling 40 children aged 5-16 years with suspected asthma. Children were referred to the Primary Care Network’s (PCN) respiratory team and invited for clinical assessment and FeNO. Patients had a 50minute appointment with a respiratory nurse specialist, or a 40minute telephone assessment with the specialist nurse followed by a 20minute HCA appointment for FeNO. Arden’s templates was used to record the consultation and FeNO test results.
Results:
51 attempted FeNO tests, 4/40 unable to do the test. 21 had a FeNO level <25ppb (low), 1 had a FeNO level 25-34ppb (intermediate), 17 had a FeNO level ≥35 (high). FeNO tests fell into 1 of 6 groups for analysis including confirmation of diagnosis, excluding diagnosis, correcting misdiagnosis and stepping down treatment. Cost per FeNO test was £14.10 and was based on machine, consumables and clinician cost as of 2020. For the misdiagnosis group, total annual savings due to deprescribing and not following up on falsely diagnosed patients with asthma was £715.15. The total 1st year cost saving for 40 patients is estimated at £925.07.
Conclusion:
FeNO is cost-effective and useful in excluding/confirming the diagnosis of asthma in children with asthma-like symptoms. Being diagnosed with greater certainty may improve engagement and adherence, resulting in fewer unscheduled care visits and expensive medication.
Conflicts of interest: A Whittamore received funding for education and delivering a webinar by NIOX
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