AOG

Vollständiger Abstract

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OBJECTIVE: To evaluate the cost effectiveness of menopausal hormone therapy (MHT) based on the risk-benefit profiles of current MHT formulations. METHODS: We used a Markov model to examine the cost effectiveness of MHT for hypothetical 50-year-old women with vasomotor symptoms compared with transdermal estradiol (E2) alone for patients without a uterus and transdermal E2 in combination with micronized progesterone for patients with a uterus, assuming 5 years of use. Using a health system perspective, we expressed the effectiveness in quality-adjusted life years (QALYs), and the willingness-to-pay threshold was set to $100,000 per QALY gained. We derived probabilities, cost data, and utilities from the literature and estimated the incremental cost-effectiveness ratios between the MHT and no MHT strategies as our primary outcome. Secondary outcomes included the number of cases of cardiovascular disease, breast cancer, colon cancer, and hip fracture and the number of deaths. RESULTS: Use of MHT demonstrated absolute dominance over not using MHT for both the E2 and E2+micronized progesterone arms. Per 10,000 patients over a lifetime, E2 compared with no MHT was $135,396,560 less expensive, resulted in a gain of 33,196 QALYs, and was associated with 259 fewer cases of atherosclerotic cardiovascular disease (ASCVD), 105 fewer colon cancer cases, 87 more breast cancer cases, 181 fewer hip fractures, and 647 fewer deaths. Micronized progesterone compared with no MHT was $127,738,990 less expensive, resulted in a gain of 33,083 QALYs, and was associated with 285 fewer cases of ASCVD, 18 more colon cancer cases, 46 more breast cancer cases, 183 fewer hip fractures, and 615 fewer deaths. Sensitivity analysis showed that variables related to ASCVD had the most effect on the model. Probabilistic sensitivity analysis revealed absolute dominance for both MHT strategies at all willingness-to-pay thresholds up to $200,000. CONCLUSION: Our model suggests that MHT is cost effective for typical patients experiencing menopausal symptoms with initiation of MHT at age 50 years and use for 5 years. The reduction in ASCVD risk by MHT is the largest driver of cost effectiveness in the model.

Abstract: PubMed · Datensatz