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Budget impact analysis of Fractional Exhaled Nitric Oxide Monitoring for the Management of Childhood Asthma: The Colombian National Health System perspective

Buendía JA1, Acuña-Cordero R2, Rodriguez-Martinez CE3

1Departamento de Farmacología y Toxicología, Facultad de Medicina, Grupo de Investigación en Farmacología y Toxicología. Universidad de Antioquia, Medellín, Colombia.
2Departamento de Neumología Pediátrica, Hospital Militar Central, Departamento de Pediatría, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
3Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia

J Investig Allergol Clin Immunol 2022; Vol. 32(3)
doi: 10.18176/jiaci.0690

Background: Fractional exhaled nitric oxide is a simple, non-invasive measurement of airway inflammation with minimal discomfort with results available within a few minutes. For policymakers, the main concerns is the economic impact implicated in adapting this technology, especially in developing countries. This study to evaluate the budget impact of asthma management using fractional exhaled nitric oxide monitoring in patients between 4 and 18 years of age in Colombia.
Methods: A budget impact analysis was performed to evaluate the potential financial impact deriving from Fractional exhaled nitric oxide. The analysis considered a 5-year time horizon and Colombian National Health System perspective. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which FeNO is reimbursed, from the cost of the conventional treatment without FeNO (management based on clinical symptoms (with or without spirometry/peak flow) or asthma guidelines (or both), for asthma-related). Univariate one-way sensitivity analyses were performed.
Results: In the base-case analysis the 5-year costs associated to FeNO and no-FeNO were estimated to be € 469.904.130 and € 480.485.149 respectively, indicating savings for Colombian National Health equal to € 10.581.019, if FeNO is adopted for the routine management of patients with persistent asthma. This result was robust in univariate sensitivity one-way analysis.
Conclusion: Fractional exhaled nitric oxide was cost-saving in emergency settings for infants with persistent asthma. This evidence can be used by decision-makers in our country to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

Key words: Fractional exhaled nitric oxide, Colombia, Persistent asthma