Bruce E. Johnson, MD; Cynda Ann Johnson, MD, MBA
Does the cost-effectiveness of hormone therapy (HT) differ between younger and older postmenopausal women?
Cost-utility analysis using a mathematical model from a societal perspective and a lifetime time horizon.
2 hypothetical cohorts of healthy postmenopausal women 50 and 65 years of age.
HT for 15 years or no HT.
In all women, HT increases risk for breast cancer and pulmonary embolism and reduces risk for colon cancer and fracture. In the younger cohort, HT reduces risk for cardiovascular events at a constant rate over the lifespan; in the older cohort, HT initially increases cardiovascular risk for a few years, then decreases it. In younger women, the improvement in quality of life with HT (through relief of menopausal symptoms) gradually decreases to nil over the first 15 years; HT does not directly affect quality of life in older women. Cost of HT is US$365 per year.
Cost per quality-adjusted life-year (QALY) gained.
HT increased QALYs by 1.5 years in younger women, with the most benefit seen in the first 15 years but maintained throughout life. In older women, HT increased QALYs by only 0.1 year and benefit began to emerge only after 10 years of use. The Table shows the cost-effectiveness of HT in the 2 cohorts.
In healthy postmenopausal women, hormone therapy increased quality-adjusted life-years and was cost-effective when started at age 50 years but not when started at age 65 years.
Lifetime cost-effectiveness of hormone therapy (HT) in hypothetical cohorts of postmenopausal women
*Age at start of treatment.
Johnson BE, Johnson CA. Postmenopausal hormone therapy was cost-effective when started at age 50 years but not at 65 years. Ann Intern Med. ;150:JC6–15. doi: 10.7326/0003-4819-150-12-200906160-02015
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Published: Ann Intern Med. 2009;150(12):JC6-15.
Healthcare Delivery and Policy, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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