Assessment of the impact of fibrates and diet on survival and their cost-effectiveness: Evidence from randomized, controlled trials in coronary heartdisease and health economic evaluations

The fibrates are one of several classes of lipid-reducing agents commonly p rescribed to reduce hypercholesterolemia a and prevent coronary heart disea se. In today's evidence-based, cost-conscious health care environment, inte rventions promoted by policymakers must provide clear clinical benefits and economic value. We assessed the evidence regarding the impact of fibrates and diet on survival and the cost-effectiveness of these interventions. A l iterature search was conducted for randomized, controlled trials of diet, f ibrates, and heart disease that were published after 1971; both primary and secondary prevention clinical trials were reviewed, and recent literature reviews and meta-analyses were searched. The evidence that diet alone impro ves survival is poor, although specifically in-creasing intake of polyunsat urated fatty acid (including n-3 fatty acids) relative to saturated fatty a cid intake may provide some clinical benefit in the secondary prevention of coronary heart disease. The cost-effectiveness of dietary intervention is also questionable because compliance is extremely poor. There is no consist ent evidence from primary or secondary prevention trials that fibrates impr ove survival; in fact, fibrates may increase the risk of death from noncoro nary causes. No consistent data suggest that fibrates are a cost-effective therapy. Because diet and fibrates do not appear to improve survival or pro vide value, policymakers should promote the use of alternative drug interve ntions that have consistently been proved to reduce mortality and are cost- effective.