The cost-effectiveness of hormone therapy in younger and older postmenopausal women.
OBJECTIVE
To evaluate the health and economic outcomes of hormone therapy in younger and older postmenopausal women.


METHODS
We developed a cost-effectiveness model to evaluate outcomes associated with hormone therapy in younger and older postmenopausal women, using data sources from published literature through March 2008. The target population was 50-year-old and 65-year-old women given hormone therapy or no therapy, and then followed over their lifetime. Primary outcomes measured were quality-adjusted life-years (QALYs) and incremental cost per QALY gained.


RESULTS
For the base-case analysis, hormone therapy for 15 years in the younger cohort resulted in a gain of 1.49 QALYs with an incremental cost of $2438 per QALY gained, compared with no therapy. The results for younger women were robust to all sensitivity analyses, and treatment remained highly cost-effective (<$10,000 per QALY gained) within the range of individual assumptions used. Treatment durations of 5 years and 30 years also were highly cost-effective. In the older cohort, treatment for 15 years resulted in a net gain of 0.11 QALYs with a cost of $27,953 per QALY gained. However, a loss of QALYs was seen in the first 9 years. The results for older women were sensitive to many of the assumptions used.


CONCLUSIONS
Hormone therapy for 5 to 30 years in younger postmenopausal women increases quality-adjusted life-years and is cost-effective. Hormone therapy started in later years results in a loss of quality-adjusted life for several years before a net gain can be realized.
Salpeter
Shelley R
SR
Department of Medicine, Santa Clara Valley Medical Center, San Jose, Calif 95128, USA. salpeter@stanford.edu
Buckley
Nicholas S
NS
Liu
Hau
H
Salpeter
Edwin E
EE
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D017698:Postmenopause; D011788:Quality of Life