Cost-outcome benefits of fibrate therapy in type 2 diabetes

To date there have been few studies focusing on economic assessments of fibrate therapy in the management of coronary heart disease (CHD), particularly in patients with type 2 diabetes. A cost-effectiveness model for an economic analysis was established by an assessment of `cost per CHD event avoided' for fibrate therapy. This model was derived from: i) data on CHD events in patients with and without diabetes from randomised controlled trials of lipid-lowering agents, ii) comparisons of fibrate and HMG CoA reductase inhibitor (statin) treatment compared to no treatment and iii) current UK-based drug and clinical event costs. Treatment benefits over a five-year period were calculated, and the sensitivity of the model to the individual variables tested. Fibrate therapy was substantially more cost-effective than statin therapy in patients with diabetes. Economic costings for fenofibrate, as the index fibrate commonly used in the UK, confirmed an annual cost of £2,642— £3,700 per CHD event avoided over a five-year assessment period. Cost-effectiveness ratios derived in the economic model demonstrated that fibrate therapy was equally effective as statin therapy, but at a 54% reduction in annual cost. Current and future CHD treatment guidelines should incorporate pharmacoeconomic data for fibrate as well as statin therapy.