Introduction
The high proportion of patients without adequate control of asthma
generates permanent challenges worldwide. For example, in Latin America,
only 2.4% of the patients with this disease have total asthma control
(1). The periodic assessment and the early management of airway
inflammation are the principal strategies, to prevent hospitalizations,
recommended for international and local clinical guidelines (2, 3). In
this sense, the frequent measure of airway inflammation during the
follow up plays an important role to anticipate the exacerbations and
optimize the use of biological and corticosteroids drugs.
Since early of the nineties, the measure of fractional exhaled nitric
oxide (FeNO) has been used as a surrogate marker for type 2 airway
inflammation(4). FeNO is a simple, noninvasive measurement of airway
inflammation with minimal discomfort to the patient and with results
available with a few minutes. FeNO correlates with airway eosinophilia
in biopsy and bronchoalveolar lavage fluid (5). Indeed, a meta-analysis
of eight clinical trials in children found that FeNO guided treatment
reduced asthma exacerbations (6). The National Institute for Health and
Care Excellence (NICE) since 2014 recommended FeNO testing in children
when asthma diagnosis unclear. However, the routine used of FeNO in
asthma, and in children, is not uniformly adopted by all countries,
especially those developing countries.
The main barriers to adopting new technologies, from policymakers, are
always doubts about their efficiency in scenarios with scarce health
resources. Different economic evaluations of the use of FeNO during
asthma management in developed countries have been demonstrated that
FeNO monitoring to guide asthma management was cost-effective in Spain,
Germany, UK, and US (7-10). In this paper, we aimed to evaluate the
cost-utility of FeNO monitoring to guide asthma management in Children
in a middle-income country from a societal perspective.