Cost-effectiveness of fenofibrate versus standard care for reducing the progression of diabetic retinopathy: An economic evaluation based on data from the LENS trial

Abstract

Aims

The LENS trial demonstrated that fenofibrate slowed the progression of diabetic retinopathy compared to placebo in participants with early diabetic eye disease. We assessed its cost-effectiveness for reducing the progression of diabetic retinopathy versus standard care from a UK National Health Service perspective.

Methods

Resource use and outcome data were collected over follow-up for participants enrolled in LENS. Mean costs were compared at 2 years and per 6-month follow-up (median 4.0 years). Within the trial, cost-effectiveness was assessed in terms of the incremental cost per case of referable disease averted. A microsimulation model, with inputs derived primarily from LENS trial data, was used to assess the incremental cost per quality-adjusted life year (QALY).

Results

Fenofibrate resulted in a mean (95% confidence interval) reduction in health service costs of -£254 (−1062 to 624) at 2 years and -£101 (−243 to 42) per 6-month follow-up. This was accompanied by a 4.4% (1.3% to 8.0%) absolute reduction in any referable diabetic retinopathy or treatment thereof at 2 years, and a 27% (9%–42%) relative reduction over follow-up. Modelled over 10 years, fenofibrate use cost an additional £6 per patient for an expected QALY gain of 0.02, costing £406 per QALY versus standard care under base case assumptions. The probability of cost-effectiveness varied from 70% to 79% at a threshold of £20,000 per QALY, depending on the price discount applied to anti-VEGF drugs.

Conclusions

Fenofibrate is likely to offer a cost-effective treatment for slowing the progression of diabetic retinopathy in people with early to moderate diabetic retinopathy or maculopathy.