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.