OBJECTIVES: Type 2 diabetics with combined hyperlipidemia are at increased risk of developing coronary heart disease (CHD). Fibrates have been shown to improve lipid parameters; thereby, decreasing CHD risk among treated patients. We compare fenofibrate to gemfibrozil treatment of combined hyperlipidemia in type 2 diabetics by determining the following: one year absolute and relative risk reductions in CHD, Number Needed to Treat (NNT) to prevent one case of CHD, and number of CHD cases prevented. METHODS: In patients with lipid parameters consistent with type 2 diabetes, absolute risk (AR) of developing CHD in one year was determined using the Anderson cardiovascular risk equation. Relative risk (RR) comparing no treatment to treatment and NNT were calculated. The number of CHD cases prevented in one year was calculated from NNT and prevalence characteristics of a 500,000 member Medicaid population. Sensitivity analyses were performed on age, smoking status, drug dose, and time horizon. RESULTS: Base case patients (60 year-old female, non-smoker) treated with fenofibrate (AR=1.1, RR=1.92, NNT=97) had lower absolute risks, more favorable relative risks comparing no treatment to treatment, and required treatment of fewer patients to prevent one case of CHD compared to gemfibrozil (AR=1.5, RR=1.42, NNT=157). In one year, in patients > 50 years, 91 CHD cases were prevented through the model with fenofibrate treatment, compared to 56 cases prevented with gemfibrozil. Each sensitivity analysis showed fenofibrate had the more favorable AR, RR, and NNT. For example, using a five year time horizon on a 70 year-old smoking male, fenofibrate's AR=17.8, RR=1.41, and NNT=14, while with gemfibrozil's AR=21.0, RR=1.20, and NNT=24. In five years, 348 cases of CHD were prevented with fenofibrate compared to 206 with gemfibrozil. CONCLUSIONS: Fenofibrate proves a better healthcare value than gemfibrozil due to its superior risk reduction and prevention of more cases of CHD.