Article Text

Original article
Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial
  1. Thijs Beerthuizen1,
  2. Sandra Voorend-van Bergen2,
  3. Wilbert B van den Hout1,
  4. Anja A Vaessen-Verberne3,
  5. Hein J Brackel4,
  6. Anneke M Landstra5,
  7. Norbert J van den Berg6,
  8. Johan C de Jongste2,
  9. Peter J Merkus7,
  10. Mariëlle W Pijnenburg2,
  11. Jacob K Sont1
  1. 1Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands
  3. 3Department of Pediatrics, Amphia Hospital, Breda, The Netherlands
  4. 4Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands
  5. 5Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
  6. 6Department of Pediatrics, Flevo Hospital—De Kinderkliniek, Almere, The Netherlands
  7. 7Department of Pediatric Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
  1. 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{at}


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 FENO 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 FENO-based strategy according to ACT and FENO 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 FENO-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 FENO-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 FENO-based strategies, these strategies may be useful additions to standard care.

Trial registration number Netherlands Trial Register (NTR1995).

  • Asthma
  • Health Economist
  • Paediatric asthma

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