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

TY - JOUR

T1 - Cost-effectiveness of fenofibrate versus standard care for reducing the progression of diabetic retinopathy

T2 - An economic evaluation based on data from the LENS trial

AU - Scotland, Graham

AU - Tsehaye, Mekazin

AU - Styles, Caroline

AU - Logue, Jennifer

AU - Sammons, Emily

AU - Zayed, Mohammed

AU - Emberson, Jonathan

AU - Wallendszus, Karl

AU - Wade, Rachel

AU - Stevens, Will

AU - Cretney, Rosanna

AU - Harding, Simon

AU - Leese, Graham

AU - Currie, Gemma

AU - Armitage, Jane

AU - Preiss, David

AU - The LENS Collaborative Group

AU - Williamson, Paula

AU - Bodansky, Jonathan

AU - Cairns, Allan

AU - Dickie, Sue

AU - Hallard, Gillian

AU - Adigwe, Gozie Joe

AU - Jones, Laura

AU - Lyons, Timothy

AU - Neely, Dermot

AU - Wild, Sarah

AU - Young, Ian

AU - Patel, Praveen

AU - Watkins, Alan

AU - Staplin, Natalie

AU - Howard, Sarah

AU - Sawyer, Kate

AU - Taylor, Karen

AU - Achiri, Patricia

AU - Burke, Andy

AU - Hurley, Susan

AU - McChlery, Gareth

AU - Wilson, Andrea

AU - Thompson, James

AU - Connelly, Paul

AU - Blaikie, Andrew

AU - Gray, Karen

AU - Jenkins, David

AU - Thompson, Joyce

AU - Finlayson, Jim

AU - Malcolm, Ellen

AU - Stewart, Lisa

AU - Colhoun, Helen

AU - Lindsay, Robert

A2 - Mackenzie, Isla

N1 - Publisher Copyright: © 2025 The Author(s). Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

PY - 2025/9

Y1 - 2025/9

N2 - 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.

AB - 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.

KW - cost-effectiveness analysis

KW - diabetic retinopathy

KW - fenofibrate

UR - https://www.scopus.com/pages/publications/105011182110

U2 - 10.1111/dme.70098

DO - 10.1111/dme.70098

M3 - Article

C2 - 40607724

AN - SCOPUS:105011182110

SN - 0742-3071

VL - 42

JO - Diabetic Medicine

JF - Diabetic Medicine

IS - 9

M1 - e70098

ER -