ORIGINAL ARTICLE Cost-effectiveness of FE NO -based and web-based monitoring in paediatric asthma management: a randomised controlled trial Thijs Beerthuizen, 1 Sandra Voorend-van Bergen, 2 Wilbert B van den Hout, 1 Anja A Vaessen-Verberne, 3 Hein J Brackel, 4 Anneke M Landstra, 5 Norbert J van den Berg, 6 Johan C de Jongste, 2 Peter J Merkus, 7 Mariëlle W Pijnenburg, 2 Jacob K Sont 1 1 Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands 2 Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center—Sophia Children’s Hospital, Rotterdam, The Netherlands 3 Department of Pediatrics, Amphia Hospital, Breda, The Netherlands 4 Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands 5 Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands 6 Department of Pediatrics, Flevo Hospital—De Kinderkliniek, Almere, The Netherlands 7 Department of Pediatric Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands Correspondence to Jacob K Sont, LUMC Quality of Care Institute, Leiden University Medical Center, J-10-S P.O. Box 9600, Leiden 2300 RC, The Netherlands; j.k.sont@lumc.nl Received 30 July 2015 Revised 17 February 2016 Accepted 27 February 2016 Published Online First 5 April 2016 To cite: Beerthuizen T, Voorend-van Bergen S, van den Hout WB, et al. Thorax 2016;71:607–613. ABSTRACT Background In children with asthma, web-based monitoring and inflammation-driven therapy may lead to improved asthma control and reduction in medications. However, the cost-effectiveness of these monitoring strategies is yet unknown. Objective We assessed the cost-effectiveness of web- based monthly monitoring and of 4-monthly monitoring of FE NO as compared with standard care. Methods An economic evaluation was performed alongside a randomised controlled multicentre trial with a 1-year follow-up. Two hundred and seventy-two children with asthma, aged 4–18 years, were randomised to one of three strategies. In standard care, treatment was adapted according to Asthma Control Test (ACT) at 4-monthly visits, in the web-based strategy also according to web-ACT at 1 month intervals, and in the FE NO -based strategy according to ACT and FE NO at 4- monthly visits. Outcome measures were patient utilities, healthcare costs, societal costs and incremental cost per quality-adjusted life year (QALY) gained. Results No statistically significant differences were found in QALYs and costs between the three strategies. The web-based strategy had 77% chance of being most cost-effective from a healthcare perspective at a willingness to pay a generally accepted €40 000/QALY. The FE NO -based strategy had 83% chance of being most cost-effective at €40 000/QALY from a societal perspective. Conclusions Economically, web-based monitoring was preferred from a healthcare perspective, while the FE NO - based strategy was preferred from a societal perspective, although in QALYs and costs no statistically significant changes were found as compared with standard care. As clinical outcomes also favoured the web-based and FE NO -based strategies, these strategies may be useful additions to standard care. Trial registration number Netherlands Trial Register (NTR1995). INTRODUCTION Asthma treatment aims at achieving and maintain- ing asthma control and therefore adjusting therapy is based on regular assessment of the level of asthma control. 1 Effective disease management requires simple, reliable and affordable tools to assess asthma control. However, guidelines offer little practical guidance for monitoring asthma in children and in clinical practice a substantial pro- portion of children does not achieve adequate asthma control which leads to increased healthcare costs and productivity loss of parents. 2–5 Web-based self-monitoring may improve asthma control in children. 6 A simple and affordable tool that can be offered via internet is the Asthma Control Test (ACT, for children >11 years) or Childhood ACT (for children 4–11 years). 7–10 In addition, since chronic airways inflammation is the target for treatment with inhaled corticosteroids (ICS) monitoring of airways inflammation is another opportunity to tailor therapy and improve asthma outcomes. 11 12 Measuring the FE NO is a non-invasive and simple method to quantify eosinophilic airways inflammation. In a recent study in children with asthma between 4 years and 18 years of age, we evaluated the effectiveness of 1 year treatment based on two different asthma monitoring strategies as compared with standard care: (1) web-based monitoring with Key messages What is the key question? ▸ Does the clinical effectiveness of FE NO -based and web-based monitoring outweigh healthcare costs and societal costs in children with allergic asthma? What is the bottom line? ▸ Both FE NO -based and web-based monitoring were economically preferred from societal and healthcare perspectives, as compared with standard care. Why read on? ▸ This paper extends the favourable clinical outcomes of FE NO -based and web-based monitoring with a detailed assessment of the health economic effects showing a higher probability of cost-effectiveness of both strategies. Beerthuizen T, et al. Thorax 2016;71:607–613. doi:10.1136/thoraxjnl-2015-207593 607 Paediatric lung disease on June 5, 2020 by guest. 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