Cost-effectiveness of hormone replacement therapy for fracture prevention in young postmenopausal women: an economic analysis based on a prospective cohort study.
A recent systematic review of randomized controlled trials has shown that hormone replacement therapy (HRT) prevents fractures when taken soon after the menopause. HRT for treatment of menopausal symptoms is relatively cost-effective, but whether its use for prevention of perimenopausal fractures is economically efficient is unknown. We undertook a 6-year follow-up of 3645 perimenopausal women who had a bone mineral density (BMD) measurement with recommendation to use HRT if low BMD was present. Data were collected on incident fractures and costs. After an average of 6.2 years of follow-up HRT use significantly reduced incident fractures by 52% (95% CI: 67% to 18%). However, costs were increased by an average of pounds sterling 275 (95% CI: pounds sterling 228 to pounds sterling 330) for the group as a whole; for hysterectomized women costs were increased less (pounds sterling 138), but this was still significantly greater than for non-HRT users (95% CI: pounds sterling 6 to pounds sterling 275). The cost per averted fracture was about pounds sterling 11 000 (95% CI: pounds sterling 8625 to pounds sterling 13 872) for the whole group and for hysterectomized women the corresponding figure was substantially less (pounds sterling 1784; 95% CI: pounds sterling 59 to pounds sterling 3532). HRT given to women at or shortly after the menopause is therefore associated with a halving of fracture incidence. Such a policy for hysterectomized women without menopausal symptoms may be cost-effective as such women are at elevated risk of fracture and need cheaper, unopposed, estrogens.
Department of Health Sciences & Centre for Health Economics, University of York, York, UK.
R
R
Fleurence
D J
DJ
Torgerson
D M
DM
Reid
D015519:Bone Density / Q000502:physiology; D003362:Cost-Benefit Analysis; D016021:Epidemiologic Studies; D015914:Estrogen Replacement Therapy / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology