Scotland Graham, Tsehaye Mekazin, Styles Caroline, Logue Jennifer, Sammons Emily, Zayed Mohammed, Emberson Jonathan, Wade Rachel, Wallendszus Karl, Stevens Will, Cretney Rosanna, Harding Simon, Leese Graham, Currie Gemma, Armitage Jane, Preiss David
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
Queen Margaret Hospital, Fife, UK.
Diabet Med. 2025 Jul 3:e70098. doi: 10.1111/dme.70098.
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.
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).
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.
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.
LENS试验表明，在患有早期糖尿病眼病的参与者中，与安慰剂相比，非诺贝特可减缓糖尿病视网膜病变的进展。我们从英国国家医疗服务体系的角度评估了其与标准治疗相比在降低糖尿病视网膜病变进展方面的成本效益。
收集了LENS试验参与者随访期间的资源使用和结局数据。比较了2年及每6个月随访（中位时间4.0年）时的平均成本。在试验中，成本效益根据避免每例可转诊疾病的增量成本进行评估。使用一个主要从LENS试验数据得出输入值的微观模拟模型来评估每质量调整生命年（QALY）的增量成本。
非诺贝特在2年时使医疗服务成本平均（95%置信区间）降低了-254英镑（-1062至624英镑），每6个月随访时降低了-101英镑（-243至42英镑）。这伴随着2年时任何可转诊的糖尿病视网膜病变或其治疗的绝对减少4.4%（1.3%至8.0%），以及随访期间相对减少27%（9% - 42%）。在10年的模拟中，使用非诺贝特每位患者额外花费6英镑来获得预期0.02的QALY增益，在基本病例假设下与标准治疗相比，每QALY成本为406英镑。根据应用于抗VEGF药物的价格折扣，在每QALY 20,000英镑的阈值下，成本效益的概率从70%到79%不等。
非诺贝特可能为减缓早期至中度糖尿病视网膜病变或黄斑病变患者的糖尿病视网膜病变进展提供一种具有成本效益的治疗方法。
