Cost effectiveness of using sputum differential cell count in chronic respiratory diseases

<bold>Background:</bold> Although the utility of sputum eosinophils (SpEo) monitoring was demonstrated over 20 years ago in reducing exacerbations, hospitalisations and healthcare costs in severe asthma (SA), it has only recently been recommended by GINA to aid phenotyping SA patients. The 2023 BTS Chronic Cough Clinical Statement also describes it as gold standard for the diagnosis of eosinophilic airway disease. And yet, it remains a very niche service only available in highly specialised centres. <bold>Aim:</bold> To assess the real-life cost benefit of sputum monitoring versus bronchoscopy (Brscpy) in the era of biologics <bold>Methods:</bold> We recorded the number of: · SA patients for whom our MDT switched biologics using SpEo (instead of Brscpy) · Chronic cough patients being referred for SpEo when Brscpy was not appropriate/torelated We compared the cost of a bronchoscopy (£832) to that of a sputum induction (£193) tariff as currently set-up within our NHS institution. <bold>Results:</bold> The savings are calculated in Table 1: <table-wrap><object-id>erj;64/suppl_68/PA1223/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td><bold>Respiratory speciality</bold></td><td><bold>Patients (n)</bold></td><td><bold>Reason for SpEo</bold></td><td><bold>Savings by using SpEo</bold></td></tr><tr><td>Severe asthma</td><td>184</td><td>support a biologics switch</td><td>121000 GBp</td></tr><tr><td>Chronic cough</td><td>45</td><td>Further phenotyping</td><td>25000 GBp</td></tr></tbody></table></table-wrap> <bold>Conclusions:</bold> SpEo offers important cost benefits. It is a less invasive, cheaper alternative to Brscpy but only when investigating airway inflammation as it cannot inform on other treatable traits. We therefore acknowledge some of these savings can be overestimated. There is a wider scope for SpEo use in respiratory conditions where inflammation is a treatable trait. It is perceived as a challenging technique but can constitute a pre-Brscpy step as sputum induction is well tolerated by patients and carries less risk than Brscpy.