title: Cost-effectiveness of raloxifene and hormone replacement therapy in postmenopausal women: impact of breast cancer risk.
abstract: OBJECTIVE
  To examine the life expectancy and cost-effectiveness of hormone replacement therapy (HRT) and raloxifene therapy in healthy 50-year-old postmenopausal women.
  
  
  METHODS
  We performed a cost-effectiveness analysis using a Markov model, discounting the value of future costs and benefits to account for their time of occurrence.
  
  
  RESULTS
  Both HRT and raloxifene therapy increase life expectancy and are cost-effective relative to no therapy for 50-year-old postmenopausal women. For women at average breast cancer and coronary heart disease risk, lifetime HRT increases quality-adjusted life expectancy more (1.75 versus 1.32 quality-adjusted life years) and costs less ($3802 versus $12,968) than lifetime raloxifene therapy. However, raloxifene is more cost-effective than HRT for women at average coronary risk who have a lifetime breast cancer risk of 15% or higher or who receive 10 years or less of postmenopausal therapy. Raloxifene is also the more cost-effective alternative if HRT reduces coronary heart disease risk by less than 20%.
  
  
  CONCLUSIONS
  Assuming the benefit of HRT in coronary heart disease prevention from observational studies, long-term HRT is the most cost-effective alternative for women at average breast cancer and coronary heart disease risk seeking to extend their quality-adjusted life expectancy after menopause. However, raloxifene is the more cost-effective alternative for women at average coronary risk with one or more major breast cancer risk factors (first-degree relative, prior breast biopsy, atypical hyperplasia or BRCA1/2 mutation). These results can help inform decisions about postmenopausal therapy until the results of large scale randomized trials of these therapies become available.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA. karmstro@mail.med.upenn.edu
authors.forename: K
authors.initials: K
authors.lastname: Armstrong
authors.forename: T M
authors.initials: TM
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Albert
authors.forename: T C
authors.initials: TC
authors.lastname: Randall
authors.forename: J S
authors.initials: JS
authors.lastname: Schwartz
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control*; D003327:Coronary Disease / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004965:Estrogen Antagonists / Q000191:economics*; D005260:Female; D006293:Health Promotion / Q000191:economics; D020249:Hormone Replacement Therapy / Q000191:economics*; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D017698:Postmenopause; D019057:Quality-Adjusted Life Years; D020849:Raloxifene Hydrochloride / Q000191:economics*; D014481:United States
chemical_list: D004965:Estrogen Antagonists; D020849:Raloxifene Hydrochloride