Is fenofibrate a cost-saving treatment for middle-aged individuals with type 2 diabetes? A South African private-sector perspective

INTRODUCTION: This project was based on the FIELD trial.1 It is a localisation of the study by Carrington and Stewart.2 The aim of the original study was to determine the impact of fenofibrate therapy on healthcare costs of middle-aged patients with type 2 diabetes at high risk of future cardiovascular events. METHODS: The methodology used in the Carrington article2 was adopted for this study. The clinical foundation for the analysis was derived from the findings of the FIELD study.1 All costs were sourced from electronic databases obtained from private-sector South African funders of healthcare. Event costs for the cardiovascular events were determined and added to the treatment costs for the individual treatment arms. The cost saving was determined as the difference between the event costs saved and the additional treatment costs associated with fenofibrate treatment. All costs were reported as 2008 ZAR and a discount rate of 10% was used. The study adopted a South African private-sector funder perspective. RESULTS: If the same approach is followed as in the Carrington and Stewart study,2 a cost saving of 18% results. This is the difference between the total costs associated with the placebo and fenofibrate arms, respectively (R3 480 471 compared to R2 858 598 per 1 000 patient years for the placebo and fenofibrate arms, respectively). The total costs were determined as the sum of associated event costs and treatment costs for each of the comparators. CONCLUSIONS: Based on this exploratory analysis, it seems that Lipanthyl® treatment in middle-aged patients resulted in a cost saving due to the prevention of cardiovascular events when it was used in the treatment of type 2 diabetics, as in the FIELD study. It should therefore be considered to be cost effective, even when just the cardiovascular risk reduction effect is considered.