Economic evaluation of FE(NO) measurement in diagnosis and 1-year management of asthma in Germany

Respir Med. 2008 Feb;102(2):219-31. doi: 10.1016/j.rmed.2007.09.008. Epub 2007 Oct 29.


Objective: Fractional exhaled nitric oxide (FE(NO)) is a marker for airway inflammation in asthma. The objective of this study was to assess the cost-effectiveness of FE(NO) measurement at a reimbursement price of euro34 using NIOX MINO, a portable non-invasive FE(NO) monitor, in asthma diagnosis and management.

Methods: Two decision trees were constructed to capture the different alternatives and consequences in asthma diagnosis and management, comparing FE(NO) measurement against standard diagnostics and treatment guidelines. The impact of asthma management with FE(NO) measurement on resource use and health outcomes was evaluated over a 1-year timeframe. A German payer perspective was chosen. Effectiveness was measured in quality-adjusted life-years.

Results: Asthma diagnosis based on FE(NO) measurement results in a cost of euro38 per patient compared with euro26 for standard diagnostics. In mild to severe patients, asthma management with FE(NO) measurement instead of standard guidelines results in cost-savings of euro30 per patient and year. In a more severe population, management with FE(NO) measurement would save costs of euro160 per patient.

Conclusion: Asthma diagnosis based on FE(NO) measurement alone (exemplified with NIOX MINO) costs euro12 more per patient than standard diagnostic methods, while offering improved accuracy. The use of FE(NO) measurement in treatment decisions is less costly than asthma management based on standard guidelines and provides similar health benefits.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asthma / diagnosis
  • Asthma / economics*
  • Biomarkers / analysis
  • Breath Tests / methods
  • Child
  • Cost-Benefit Analysis
  • Germany
  • Humans
  • Middle Aged
  • Models, Economic
  • Nitric Oxide / analysis*
  • Practice Guidelines as Topic
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity


  • Biomarkers
  • Nitric Oxide