The cost-effectiveness of hormone therapy in younger and older postmenopausal women

Am J Med. 2009 Jan;122(1):42-52.e2. doi: 10.1016/j.amjmed.2008.07.026.

Abstract

Purpose: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging*
  • Computer Simulation
  • Cost-Benefit Analysis
  • Decision Trees
  • Estrogen Replacement Therapy / adverse effects
  • Estrogen Replacement Therapy / economics*
  • Female
  • Humans
  • Middle Aged
  • Models, Biological
  • Postmenopause
  • Quality of Life