Cost-effectiveness of continuous combined hormone replacement therapy in long-term use: economic evaluation based on a 9-year study in Finland

Headnote

Key words: Cancer - CHD - Cost-effectiveness - Fracture - Low-dose continuous combined hormone replacement therapy - Quality-adjusted life-year, QALY - Stroke

ABSTRACT

Objectives: To investigate the cost-effectiveness of continuous combined hormone replacement therapy (ccMRT) (Indivina*) in postmenopausal women in Finland treated for up to nine consecutive years in the course of a randomised controlled trial.

Methods: In-study event data were accrued for cardiac and vascular events, cancers and fractures. These event incidence data were applied to firstyear direct medical costs for these events, derived from published sources. Reference event Incidence data were derived from hospital discharge records and relevant national registries for agematched women (aged 50-70 years) in Finland with an assumed HRT usage rate of 40%. Cost-effectiveness was expressed as additional cost per quality-adjusted life year (QALY) gained for women on ccHRT compared with the general population. All Input data were discounted at 3% per annum.

Results: The additional cost per QALY gained for ccHRT was less than euro5000 throughout the nine calendar years examined and remained well below the threshold of acceptability of euro50000 in a range of sensitivity analyses. The lowest dose-combination of ccHRT examined improved quality of life at no greater cost than no treatment.

Conclusions: This appraisal, based on event data from a uniquely long study of ccHRT, indicates that this intervention is cost-effective for the relief of symptoms of menopause.

Introduction

Hormone replacement therapy (HRT) is an important resource for many women in controlling symptoms of menopause and in preventing the deterioration in health-related quality of life (HRQoL) that these symptoms may cause1-5.

For women with an intact uterus use of combination (oestrogen plus progestogen) therapy is used to counter the effects of unopposed oestrogen in the endometrium. Continuous combined HRT (ccHRT) is a popular form of combined treatment6. The longestrunning randomised study of ccHRT to have been reported was commenced in 1994 when Heikkinen and colleagues initiated a study of oestradiol valerate (E2V) and medroxyprogesterone acetate (MPA) (Indivina) in a cohort of 419 postmenopausal non-hysterectomised women in Finland. Treatment was ultimately continued for nine consecutive years, during which time the study provided insights on the impact of ccHRT on menopausal symptoms, bone mineral density and lipid profile, as well as generating an extensive safety and...