In a large skillet over medium heat, cook 1 pound ground sausage until browned. Drain any excess grease.
Add ½ diced onion to the skillet and cook for 3–4 minutes until softened.
Stir in 1 can (14.5 oz) fire roasted diced tomatoes, 2 ½ cups water, 1 teaspoon Italian seasoning, ½ teaspoon salt, and ½ teaspoon pepper.
Bring the mixture to a boil, then add 8 oz elbow macaroni. Stir to combine.
Uncover and then remove the pan from the heat.
Stir in ½ cup half and half and 2 cups shredded cheddar cheese. Mix until the cheese is fully melted and the sauce is creamy.
Remove from heat and let sit for a few minutes to thicken before serving.
Video
Notes
*Refrigerate the leftovers in an air tight container for up to 5 days. You can easily make this recipe with ground beef or ground sausage if you prefer. We recommend shredding your own cheddar cheese for this recipe as it melts smoother and is more creamy.