Is icosapent ethyl (omega-3 fatty acid) less expensive than fenofibrate?

Cost Comparison Between Icosapent Ethyl and Fenofibrate

No, icosapent ethyl (omega-3 fatty acid) is not less expensive than fenofibrate. 1

Cost Analysis

Fenofibrate is significantly more cost-effective than icosapent ethyl for treating hypertriglyceridemia:

• Icosapent ethyl has an annual cost of approximately £2064 (roughly $2,600) in the UK 1
• Fenofibrate is not only less expensive but actually demonstrates cost savings in both primary and secondary cardiovascular prevention settings 1
• Cost-effectiveness analysis shows fenofibrate yields cost savings of approximately £6,127 in primary prevention and £637 in secondary prevention settings 1

Comparative Cost-Effectiveness

When comparing these medications from a cost-effectiveness perspective:

• Fenofibrate demonstrates a negative incremental cost-effectiveness ratio (ICER) of -£9,932/QALY for primary prevention and -£7,472/QALY for secondary prevention, indicating it saves money while improving outcomes 1
• Icosapent ethyl shows a positive ICER of £19,485/QALY for primary prevention and £13,285/QALY for secondary prevention, indicating additional costs 1

Clinical Considerations Affecting Cost

Several factors influence the overall cost considerations:

• Fenofibrate is available as a generic medication, which substantially reduces its cost compared to brand-name icosapent ethyl
• The American Diabetes Association specifically recommends gemfibrozil (another fibrate) as an alternative to fenofibrate for patients who cannot afford fenofibrate, indicating that fibrates as a class are considered more affordable options 2
• Dosing requirements may affect overall cost:
  • Fenofibrate is typically dosed at 96-160 mg daily 2
  • Icosapent ethyl requires 4g daily dosing (typically 2g twice daily) for cardiovascular risk reduction 3

Efficacy Comparison

While cost is important, efficacy should also be considered:

• Fenofibrate reduces triglycerides by approximately 29-30% 4, 5
• Icosapent ethyl reduces triglycerides by approximately 21% 4
• Combination therapy with omega-3 fatty acids and fenofibrate provides superior triglyceride reduction (41%) compared to either agent alone 5

Important Considerations for Medication Selection

When selecting between these medications, consider:

1. Renal function: Fenofibrate requires dose adjustment in renal impairment and is contraindicated in severe renal impairment (GFR <30 mL/min/1.73 m²) 2

2. Cardiovascular risk: Icosapent ethyl has demonstrated significant cardiovascular event reduction in the REDUCE-IT trial, while fenofibrate has not consistently shown cardiovascular outcome benefits 3

3. Drug interactions: Fenofibrate has more significant drug interactions, particularly with statins (increased myopathy risk) and warfarin 2

4. Atrial fibrillation risk: High-dose omega-3 fatty acids including icosapent ethyl are associated with increased risk of atrial fibrillation (3.1% vs. 2.1% in placebo) 3

In summary, fenofibrate is clearly the more cost-effective option for triglyceride lowering, but medication selection should consider the patient's overall cardiovascular risk profile, renal function, and concomitant medications.