Monitoring FeNO Reduces Asthma Hospitalizations, Saves Costs

Monitoring fractional exhaled nitric oxide (FeNO) in asthma patients with a history of exacerbations has been linked to a reduction of asthma-related inpatient hospitalization (IR) or emergency department (ED) claims, according to a new study.

In analysis presented at the 2018 American Academy of Allergy, Asthma, and Immunology (AAAAI)/World Allergy Organization (WAO) Joint Congress in Orlando, FL, researchers built on recent data that showed asthma exacerbation benefits through FeNO monitoring. In a recent meta-analysis study, FeNO monitoring was associated with 40-50% reduction in exacerbation risk for patients with asthma.

The meta analysis also indicated FeNO monitoring held potential for significant patient cost savings — an indication researchers attempted to verify through their IP/ED association study.

Led by Marc Massanari, PharmD, vice president of Global Medical Affairs at Circassia, the team ran a retrospective observational study of asthma-related claims from a Medicare database. Patients included in the study had at least 2 years of records following an asthma-related IP or ED claim, as well as history of an asthma-related event from within that year.

Of the 2,828 identified patients with asthma, 63 who met the inclusion criteria within the database had a FeNO test completed during the 2-year study. Crossover analysis of patients’ asthma-related IP/ED claims were completed before and during FeNO monitoring.

Researchers reported that 61 (97%) patients had an asthma-related IP/ED event prior to FeNO monitoring, while just 30 (48%) had such an event during FeNO monitoring. IP/ED claims per day prior to FeNO monitoring was 0.026 per patient (P < 0.003) — an estimated care cost of $12,368. In post-FeNO monitoring, IP/ED claims per day were 0.003 per patient (P < 0.0043), which costs an estimated $1340.

Researchers concluded that FeNO monitoring’s effect on IP/ED claims due to asthma was substantial, and the data supports estimates that the practice is a cost-effective measure for asthma management.

Massanari told MD Magazine the impact of FeNO monitoring was a “dramatic effect” on patients with asthma.

“During monitoring, the likelihood of an attack moved out — in other words, it was extended &mdash; almost two-fold,” Massanari said. “I think it shows the benefit, that FeNO monitoring helps patients stay in better control and free of asthma exacerbation.”

Massanari explained that monitoring FeNO is important for asthma care because of its ability to uncover the airway inflammation aspect of the condition.

“There really is no other biomarker test on the market today that allows a clinician at the bedside to know how inflammation is in a patient’s lung,” Massanari said. “So it’s an important test, and I think it has a very large impact on the clinician to then assess the patient and improve their level of asthma control.”

The study, "Comparative Cost Analysis of Monitoring Exhaled Nitric Oxide (FeNO) in Asthma Management," was published online at the Journal of Allergy and Clinical Immunology.