CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 1, January/February 2010
46
AFRICA
relating to treatment costs and resource utilisation.
A cost-effectiveness threshold of ZAR95 000 per QALY
(quality-adjusted life year) has been used. This is the equivalent
of one times the South African per capita GDP, which should be
considered a very conservative estimate relevant to international
convention.
A cost–consequence analysis was conducted. This compares
the health intervention of interest with one or more relevant
alternatives, listing the cost components and various outcomes
of each intervention separately. This type of economic analysis
does not indicate the relative importance of the components
listed and leaves it to the decision maker to form his or her own
view. It makes few assumptions and places the greatest burden
on the user of the analysis. This may pose some risk and the
client will be advised accordingly. The analysis does not combine
the costs and consequences of the comparator interventions.
Cost–consequence studies are based on the premise that the users
of the study have the knowledge and experience to make value
judgements on the trade-offs.
This was followed by a cost–benefit analysis, which compares
drugs or programmes by expressing both outcomes and resource
utilisation in monetary terms in a situation where, for a given
level of resources, the decision maker wishes to maximise the
health benefits conferred to the population of concern.
A budget impact analysis assessed the net cost impact of the
intervention compared with the standard therapy for any defined
target population as per the perspective of the study. In this
analysis the total costs associated with each treatment arm were
expressed as the sum of event costs and treatment costs.
The costs used in this analysis were obtained from three
sources. These were electronic databases obtained from private-
sector healthcare funders. These sources are indicated per event
in Table 1. The coronary revascularisation and angiography costs
were derived from a Healthcorp database, MI event costs were
obtained from a Medihelp database, and stroke and other revas-
cularisation costs were obtained from a Solution database.
All treatment costs are SEP (single exit price) including VAT
and are reported for the same exposure period as the cardiovas-
cular events. The treatment costs are therefore expressed as cost
per 1 000 person years of treatment.
A one-way sensitivity analysis was conducted using the 95%
confidence intervals of the event rates. These results are reported
in Tables 2 and 3.
Results
The cost-effectiveness analysis was based on the methodology
described in the article by Carrington and Stewart.
2
The results
from this analysis are reported in Table 1.
As is evident from this table, fenofibrate therapy was consist-
ently associated with a reduction in the incidence of cardiac
events. Per 1 000 person years, fenofibrate therapy was therefore
associated with a cost saving of R706 254 resulting from events
avoided over the 1 000 person-year observation period. This
amount was calculated as the product of the unit cost of an event
and the number of events per 1 000 person years estimated to be
associated with the respective treatment arms.
To this we then added therapy costs. Fenofibrate therapy
resulted in an increase of R84 381 in pharmacotherapy costs. The
sum total of the event costs and therapy costs was calculated to
be R 3 480 471 in respect of the placebo arm and R 2 858 598 for
the fenofibrate therapy. A resultant cost saving of R 621 873 was
modelled to result from the introduction of fenofibrate treatment
to the treatment of middle-aged type 2 diabetics.
The one-way sensitivity analysis (see Tables 2 and 3) indi-
cated that the analysis was robust as far as the event-rate assump-
tions were concerned. Both for the upper and lower 95% limits,
a cost saving associated with fenofibrate was indicated (R1.098
million and R84 000, respectively).
Conclusion
Based on this analysis, it appeared that Lipanthyl
®
resulted in
a cost saving due to the prevention of cardiovascular events,
including myocardial infarction and stroke, 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. The addition
of fenofibrate should therefore be favourably considered for
inclusion in the management regimes for type 2 diabetes.
These results were indicated to be robust to the assumptions
made regarding the event rates, as was suggested by the one-way
sensitivity analyses that were done.
References
The FIELD study investigators. Effects of long-term fenofibrate
1.
therapy on cardiovascular events in 9795 people with type 2 diabetes
mellitus (the FIELD study): randomised controlled trial.
Lancet
2005;
366
(9500): 1849–1861.
Carrington Melinda, Stewart Simon. Is fenofibrate a cost-saving treat-
2.
ment for middle-aged individuals with type II diabetes? An economic
analysis of the FIELD study.
Int J of Cardiol
2008;
127
: 51–56.
Rees A. FIELD study.
3.
Diabet Med
2006;
23
(Suppl 3): 6–12.
Keech AC, Mitchell P, Summanen PA,
4.
et al
. Effect of fenofibrate on
the need for laser treatment for diabetic retinopathy (FIELD study): a
randomised controlled trial.
Lancet
2007;
370
: 1687–1697
