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Summary 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 €34 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 €38 per patient compared with €26 for standard diagnostics. In mild to severe patients, asthma management with FE NO measurement instead of standard guidelines results in cost-savings of €30 per patient and year. In a more severe population, management with FE NO measurement would save costs of €160 per patient. Conclusion Asthma diagnosis based on FE NO measurement alone (exemplified with NIOX MINO) costs €12 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.