title: Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial.
abstract: 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.
  
  
  
  We assessed the cost-effectiveness of web-based monthly monitoring and of 4-monthly monitoring of FENO as compared with standard care.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Netherlands Trial Register (NTR1995).
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Thijs
authors.identifier: 0000-0002-8998-3407
authors.initials: T
authors.lastname: Beerthuizen
authors.affiliation: Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Voorend-van Bergen
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
authors.affiliation: Department of Pediatrics, Amphia Hospital, Breda, The Netherlands.
authors.forename: Anja A
authors.initials: AA
authors.lastname: Vaessen-Verberne
authors.affiliation: Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Brackel
authors.affiliation: Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Anneke M
authors.initials: AM
authors.lastname: Landstra
authors.affiliation: Department of Pediatrics, Flevo Hospital-De Kinderkliniek, Almere, The Netherlands.
authors.forename: Norbert J
authors.initials: NJ
authors.lastname: van den Berg
authors.affiliation: Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.affiliation: Department of Pediatric Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Merkus
authors.affiliation: Division Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Mariëlle W
authors.initials: MW
authors.lastname: Pijnenburg
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Sont
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D018670:Monitoring, Ambulatory / Q000191:economics* / Q000379:methods*; D009426:Netherlands; D009569:Nitric Oxide / Q000032:analysis*; D019057:Quality-Adjusted Life Years; D012129:Respiratory Function Tests
chemical_list: D018927:Anti-Asthmatic Agents; D009569:Nitric Oxide
keywords: Asthma; Health Economist; Paediatric asthma