Fenofibrate cost-effective for preventing diabetic retinopathy progression
In diabetes patients with mild background retinopathy in both eyes or observable background retinopathy or maculopathy in one or both eyes, treatment with fenofibrate reduced the need for any referable diabetic retinopathy or treatment by 4.4% over two years, an analysis of a randomized trial found.
Fenofibrate is a cost-effective treatment for slowing the progression of diabetic retinopathy in patients with early to moderate diabetic retinopathy or maculopathy, results of an economic evaluation carried out in Scotland suggest.
Researchers used follow-up data from participants in the Lowering Events in Non-proliferative retinopathy in Scotland (LENS) randomized trial. Participants were adults with diabetes and observable retinopathy, defined as mild background retinopathy in both eyes or observable background retinopathy or maculopathy in one or both eyes. They were randomized to fenofibrate, 145 mg (n=576), or matched placebo (n=575). For this analysis, researchers determined cost-effectiveness by the incremental cost per case of referable disease averted and used a microsimulation model to assess the incremental cost per quality-adjusted life year (QALY). Findings were published by Diabetic Medicine on July 3.
Fenofibrate use led to a mean reduction in health service costs of −£254 (95% CI, −£1,062 to £624) at two years and −£101 (95% CI, −£243 to £42) per six-month follow-up. This was accomplished by a 4.4% (95% CI, 1.3% to 8.0%) absolute reduction in any referable diabetic retinopathy or treatment at two years and a 27% (95% CI, 9% to 42%) relative reduction over follow-up. The treatment cost an additional £6 per patient for an expected QALY gain of 0.02 over 10 years, costing £406 per QALY versus standard care.
At a threshold of £20,000 per QALY, the probability of cost-effectiveness varied from 70% to 79% depending on the price discount applied to anti-vascular endothelial growth factor drugs. Incremental cost-effectiveness ratios were favorable across subgroups, particularly in patients with type 1 diabetes, HbA1c levels of at least 64 mmol/mol (8%), and observable maculopathy at baseline.
Limitations include a lack of data on potentially relevant costs falling on social services or patients and their families and on primary care resource use.
“Treatment of patients with early diabetic retinopathy with fenofibrate can be expected to generate future resource savings in ophthalmology outpatient services, offsetting additional fenofibrate acquisition costs and maintaining the visual function and health status of patients with less need for invasive treatment,” the authors concluded.