A cost-effectiveness evaluation of two continuous-combined hormone therapies for the management of moderate-to-severe vasomotor symptoms.
OBJECTIVE
After the release of the results of the Women's Health Initiative, an emerging consensus suggests that continuous-combined hormone therapy (CCHT) should be limited to short-term management of moderate-to-severe vasomotor symptoms. This, in turn, raises the important question of the economic value, if any, of short-term CCHT for this indication. We conducted a cost-effectiveness analysis comparing a 1-year treatment course with 1 mg of norethindrone acetate/5 microg of ethinyl estradiol (1/5 NA/EE) or 0.625 mg/day of conjugated estrogens plus 2.5 mg of medroxyprogesterone (0.625/2.5 CEE/MPA) compared with no therapy for the management of moderate-to-severe vasomotor symptoms.


METHODS
A literature-based Markov model was developed to compare these three options' cost and quality-of-life (QOL) benefits. The impact of therapy on vasomotor symptoms and breakthrough bleeding/spotting on the direct costs of care and QOL were considered.


RESULTS
Compared with no therapy, CCHTs resulted in net increases in quality-adjusted life-years (QALYs) gained (0.110 for 1/5 NA/NE v 0.104 for 0.625/2.5 CEE/MPA). Net costs (v no therapy) were $167 lower for 1/5 NA/NE compared with 0.625/2.5 CEE/MPA. Cost per QALY gained (compared with no therapy) were $6,200 and $8,200, respectively. Cost-effectiveness was most favorable for individuals with more severe symptoms who were less bothered by breakthrough bleeding/spotting.


CONCLUSIONS
A short-term course of CCHT for the sole purpose of managing moderate-to-severe vasomotor symptoms is cost-effective. However, 1/5 NA/NE seemed to be more cost-effective than 0.625/2.5 CEE/MPA. These findings can be used to further refine the role of CCHT and to improve formulary decisions.
Botteman
Marc F
MF
Abt Associates Inc., Bethesda, MD, USA; Pfizer Inc., New York, NY, USA.
Shah
Nisha P
NP
Lian
Jean
J
Pashos
Chris L
CL
Simon
James A
JA
D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy / Q000191:economics*; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000191:economics; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000191:economics; D005260:Female; D019584:Hot Flashes / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D008525:Medroxyprogesterone / Q000008:administration & dosage; D008875:Middle Aged; D018803:Models, Economic; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D000077563:Norethindrone Acetate; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D014481:United States
D004966:Estrogens, Conjugated (USP); D004997:Ethinyl Estradiol; D000077563:Norethindrone Acetate; D008525:Medroxyprogesterone; D009640:Norethindrone