دورية أكاديمية
Cost-Effectiveness of Fractional Exhaled Nitric Oxide Suppression Testing as an Adherence Screening Tool Among Patients With Difficult-to-Control Asthma.
| العنوان: | Cost-Effectiveness of Fractional Exhaled Nitric Oxide Suppression Testing as an Adherence Screening Tool Among Patients With Difficult-to-Control Asthma. |
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| المؤلفون: | Barry LE; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK., O'Neill C; Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK., Butler C; Belfast Health & Social Care Trust, Belfast, UK., Chaudhuri R; School of Infection and Immunity, Gartnavel General Hospital, Glasgow, and University of Glasgow, Glasgow, UK., Heaney LG; Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK. Electronic address: l.heaney@qub.ac.uk. |
| المصدر: | The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2023 Jun; Vol. 11 (6), pp. 1796-1804.e3. Date of Electronic Publication: 2023 Mar 20. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101597220 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2213-2201 (Electronic) NLM ISO Abbreviation: J Allergy Clin Immunol Pract Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier Inc., [2013]- |
| مواضيع طبية MeSH: | Fractional Exhaled Nitric Oxide Testing* , Asthma*/diagnosis , Asthma*/drug therapy, Adult ; Humans ; Cost-Benefit Analysis ; Nitric Oxide ; Adrenal Cortex Hormones/therapeutic use |
| مستخلص: | Background: Approximately 50% of adults on long-term asthma medication are nonadherent. Current methods to detect nonadherence have had limited effect. Fractional exhaled nitric oxide suppression testing (FeNOSuppT) has demonstrated clinical effectiveness as an adherence screening tool to detect poor adherence to inhaled corticosteroids in difficult-to-control asthma prior to initiation of expensive biologic therapy. Objective: Estimate the cost effectiveness and budget impact of FeNOSuppT as a screen prior to the initiation of biologic therapy among U.S. adults with difficult-to-control asthma and high fractional exhaled nitric oxide (≥45 ppb). Methods: A decision tree simulated the progression of a cohort of patients over a 1-year time horizon into 1 of 3 states ([1] discharged from or [2] remain in specialist care; or [3] progress to biologics). Two strategies, with and without FeNOSuppT, were examined and the incremental net monetary benefit estimated using a discount rate of 3% and a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY). Sensitivity analysis and a budget impact analysis were also undertaken. Results: In the baseline scenario, FeNOSuppT prior to the initiation of biologic therapy was associated with lower costs ($4,435/patient) and fewer QALYs (0.0023 QALY/patient) compared with no FeNOSuppT over 1 year and was considered cost effective (incremental net monetary benefit = $4,207). The FeNOSuppT was consistently found to be cost effective across a range of scenarios and in deterministic and probabilistic sensitivity analyses. Assuming differential levels of FeNOSuppT uptake (20%-100%), this was associated with budget savings ranging from USD $5 million to $27 million. Conclusions: The FeNOSuppT is likely to be cost effective as a protocol-driven, objective, biomarker-based tool for identifying nonadherence in difficult-to-control asthma. This cost effectiveness is driven by cost savings from patients not progressing to expensive biologic therapy. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) |
| معلومات مُعتمدة: | MR/M016579/1 United Kingdom MRC_ Medical Research Council |
| فهرسة مساهمة: | Keywords: Adherence; Asthma; Biologic; Corticosteroid; Cost-effective; Decision tree; Difficult-to-control; Economic; Fractional exhaled nitric oxide; Suppression test |
| المشرفين على المادة: | 31C4KY9ESH (Nitric Oxide) 0 (Adrenal Cortex Hormones) |
| تواريخ الأحداث: | Date Created: 20230320 Date Completed: 20230612 Latest Revision: 20231120 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.jaip.2023.03.008 |
| PMID: | 36940864 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2213-2201 |
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| DOI: | 10.1016/j.jaip.2023.03.008 |