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

<strong>Aims:</strong> The LENS trial demonstrated that fenofibrate slowed progression of diabetic retinopathy compared to placebo in participants with early diabetic eye disease. We assessed its cost-effectiveness for reducing progression of diabetic retinopathy versus standard care from a UK National Health Service perspective. <br> <strong>Methods:</strong> Resource use and outcome data were collected over follow-up for participants enrolled in LENS. Mean costs were compared at two years and per 6-months follow-up (median 4.0 years). Within trial cost-effectiveness was assessed in terms of 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). <br> <strong>Results:</strong> Fenofibrate resulted in a mean (95% confidence interval) reduction in health service costs of -£254 (-1,062 to 624) at two years and -£101 (-243 to 42) per 6-months 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 two years, and a 27% (9%-42%) relative reduction over follow-up. Modelled over ten 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%-79% at a threshold of £20,000 per QALY, depending on the price discount applied to anti-VEGF drugs. <br> <strong>Conclusions:</strong> Fenofibrate is likely to offer a cost-effective treatment for slowing progression of any diabetic retinopathy in people with early to moderate diabetic retinopathy or maculopathy.