title: Economic evaluation of norethisterone acetate/ethinylestradiol (FemHRT) for women with menopausal symptoms.
abstract: BACKGROUND
  The objective of this study was to assess the cost effectiveness of a continuous combined oral preparation of norethisterone (norethindrone) acetate and ethinylestradiol (NA/EE) [FemHRT] as both a first-line and second-line therapy for menopausal women.
  
  
  CONCLUSIONS
  Third-party payer.
  
  
  METHODS
  The cost effectiveness of NA/EE was assessed as both a first- and second-line therapy in comparison with conjugated equine oestrogen 0.625mg and medroxyprogesterone acetate 2.5mg (CEE/MPA) and no therapy. Analysis was conducted within a Markov model with states relating to the presence and absence of vaginal bleeding, menopausal symptoms and hip fracture. Analysis forecasted life expectancy, QALYs and lifetime costs for a 50-year-old menopausal woman. Compliance was modelled related to menopausal symptoms and vaginal bleeding. For the base-case analysis, it was assumed that compliant women would take therapy for up to 5 years. Sensitivity analysis assumed therapy was taken only for 1 year.
  
  
  RESULTS
  Compared with both CEE/MPA and no therapy, NA/EE led to an increase in both costs and QALYs, both as a first- and second-line therapy. For first-line therapy, the incremental cost per QALY gained for NA/EE was $2200 Canadian dollars ($Can; 1999 values) [compared with no therapy] and was $Can20 300 (compared with CEE/MPA). For second-line therapy, the incremental cost per QALY gained for NA/EE was $Can900 (compared with no therapy) and was $Can16 400 (compared with CEE/MPA). Results were robust to most sensitivity analyses.
  
  
  CONCLUSIONS
  NA/EE is a cost-effective therapy for women with menopausal symptoms both as a first-line and second-line therapy.
authors.affiliation: Clinical Epidemiology, Ottawa Health Research Institute, Ottawa Hospital Department of Medicine and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada. dcoyle@ohri.ca
authors.forename: Douglas
authors.initials: D
authors.lastname: Coyle
authors.forename: Ann
authors.initials: A
authors.lastname: Cranney
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017850:Economics, Pharmaceutical; D045166:Estradiol Congeners / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008593:Menopause / Q000187:drug effects*; D008875:Middle Aged; D009640:Norethindrone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years
chemical_list: D045166:Estradiol Congeners; D004997:Ethinyl Estradiol; D009640:Norethindrone