Hormone replacement therapy in a risk-benefit perspective.
The relative cost-effectiveness of different treatment strategies for hormone replacement therapy (HRT) was assessed within the framework of a computer model. Where data were lacking, it was necessary to make assumptions about the effects of HRT, particularly in relation to combined oestrogen-progestogen therapy and cardiovascular disease; however, sensitivity analyses were performed to assess the impact of changing these assumptions on the cost-effectiveness equation. It appears that net expenditure by the NHS will depend critically on the direct costs of treatment, rather than on any indirect costs incurred or saved as a result of side-effects. In terms of mortality, a reduction in cardiovascular disease risk would have greatest impact and would overshadow any small increase in breast cancer risk which may be associated with long-term use. If the cardioprotective effect of oestrogen is real, our results suggest that long-term prophylactic treatment of hysterectomised women would be relatively cost-effective. Treatment of symptomatic menopausal women for any period of time appears to offer very good value for money. The lack of data relating to combined oestrogen-progestogen therapy and cardioprotection, and the major importance of the latter in the equation of benefits and risks, make it more difficult to draw conclusions about the cost-effectiveness of treating non-hysterectomised asymptomatic women for prophylactic reasons.
Daly
E
E
Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, UK.
Vessey
M P
MP
Barlow
D
D
Gray
A
A
McPherson
K
K
Roche
M
M
D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D003198:Computer Simulation; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004107:Dilatation and Curettage / Q000191:economics; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000191:economics*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics; D008593:Menopause / Q000187:drug effects*; D018803:Models, Economic; D017202:Myocardial Ischemia / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors
D004967:Estrogens