A COMPUTER MODEL TO ANALYZE THE COST-EFFECTIVENESS OF HORMONE REPLACEMENT 
THERAPY

This paper gives a detailed presentation of a computer model for evaluating the cost-effectiveness (CE) of hormone replacement therapy (HRT), describing the model's design, structure, and data requirements. The model needs data specified for costs, quality of life, risks, and mortality rates. As an illustration, the CE of HRT in Sweden is calculated. Two treatment strategies are evaluated for asymptomatic women: estrogen-only therapy and estrogen combined with a progestin. The model produces similar results compared with earlier studies. The CE ratios improve with the size of the risk reduction and generally with age. Further, estrogen-only therapy is associated with a lower cost per gained effectiveness unit compared with combined therapy. Uncertainty surrounding the long-term effects of HRT means that the CE estimates should be interpreted carefully. The model permits the inclusion of indirect costs and costs in added life-years, allowing the analysis to be made from a societal perspective, which is an improvement relative to previous studies.

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Reassessment of the cost-effectiveness of hormone replacement therapy in Sweden: Results based on the Women's Health Initiative randomized controlled trial

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462305050609 ◽

2005 ◽

Vol 21 (4) ◽

pp. 433-441 ◽

Cited By ~ 20

Author(s):

Niklas Zethraeus ◽

Fredrik Borgström ◽

Bengt Jönsson ◽

John Kanis

Keyword(s):

Quality Of Life ◽

Hormone Replacement Therapy ◽

Cost Effectiveness ◽

Replacement Therapy ◽

Hormone Replacement ◽

Cost Effective ◽

Menopausal Symptoms ◽

Health Initiative ◽

The Cost

Objectives:The purpose of the study is to reassess the cost-effectiveness of hormone replacement therapy (HRT) based on new medical evidence found in the Women's Health Initiative (WHI). Within a model framework using an individual state transition model, the cost-effectiveness of 50- to 60-year-old women with menopausal symptoms is assessed based on a societal perspective in Sweden.Methods:The model has a 50-year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: coronary heart disease, stroke, venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture, and wrist fracture. An intervention is modeled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality-adjusted life years (QALYs) with and without intervention. The resulting cost per QALY gained is compared with the value of a QALY gained, which is set to SEK 600,000. The model requires data on clinical effects, risks, mortality rates, quality of life weights, and costs valid for Sweden.Results:The cost-effectiveness ratios are estimated at approximately SEK 10,000, which is below the threshold value of cost-effectiveness. On the condition that HRT increases the quality of life weight more than 0.013 units, the therapy is cost-effective.Conclusions:In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.

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The cost-effectiveness of growth hormone replacement therapy (Genotropin®) in hypopituitary adults in Sweden

Cost Effectiveness and Resource Allocation ◽

10.1186/1478-7547-11-24 ◽

2013 ◽

Vol 11 (1) ◽

pp. 24 ◽

Cited By ~ 6

Author(s):

Kristian Bolin ◽

Rickard Sandin ◽

Maria Koltowska-Häggström ◽

Jane Loftus ◽

Christin Prütz ◽

...

Keyword(s):

Growth Hormone ◽

Hormone Replacement Therapy ◽

Cost Effectiveness ◽

Replacement Therapy ◽

Hormone Replacement ◽

Growth Hormone Replacement ◽

Growth Hormone Replacement Therapy ◽

The Cost

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PCV22 THE COST EFFECTIVENESS OF HORMONE REPLACEMENT THERAPY (HRT) FOR WOMEN WITH MENOPASUAL SYMPTOMS IN SWEDEN

Value in Health ◽

10.1016/s1098-3015(10)65804-4 ◽

2004 ◽

Vol 7 (6) ◽

pp. 691-692

Author(s):

F Borgström ◽

N Zethraeus ◽

O Johnell ◽

J Kanis ◽

B Jönsson

Keyword(s):

Hormone Replacement Therapy ◽

Cost Effectiveness ◽

Replacement Therapy ◽

Hormone Replacement ◽

The Cost

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The Long-Term Effects of Oral and Transdermal Postmenopausal Hormone Replacement Therapy on Nitric Oxide, Endothelin-1, Prostacyclin, and Thromboxane

Fertility and Sterility ◽

10.1016/s0015-0282(98)00028-4 ◽

1998 ◽

Vol 69 (5) ◽

pp. 883-888 ◽

Cited By ~ 50

Author(s):

O Ylikorkala

Keyword(s):

Nitric Oxide ◽

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Hormone Replacement ◽

Long Term Effects ◽

Postmenopausal Hormone ◽

Endothelin 1 ◽

Postmenopausal Hormone Replacement Therapy

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Long-term effects of hormone replacement therapy

The Lancet ◽

10.1016/s0140-6736(03)12280-5 ◽

2003 ◽

Vol 361 (9353) ◽

pp. 254 ◽

Cited By ~ 2

Author(s):

Norman N Chan ◽

Peter CY Tong ◽

CC Chow ◽

Juliana CN Chan

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Hormone Replacement ◽

Long Term Effects

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Sex Hormone Replacement Therapy in Turner Syndrome: Impact on Morbidity and Mortality

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz039 ◽

2019 ◽

Vol 105 (2) ◽

pp. 468-478 ◽

Cited By ~ 3

Author(s):

Mette H Viuff ◽

Agnethe Berglund ◽

Svend Juul ◽

Niels H Andersen ◽

Kirstine Stochholm ◽

...

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Turner Syndrome ◽

Hormone Replacement ◽

Osteoporotic Fractures ◽

Long Term Effects ◽

Mortality And Morbidity ◽

Central Registry ◽

National Cohort ◽

The Impact

Abstract Context The long-term effects of female hormone replacement therapy (HRT) in Turner syndrome (TS) are unknown. Objective To examine morbidity, mortality and medicinal use in TS and the impact of HRT in 45,X women. Design and Setting National cohort study, following all TS individuals ever diagnosed in Denmark from 1977 to 2014. Patients and Methods In the Danish Cytogenetic Central Registry, we identified 1156 females diagnosed with TS from 1960 to 2014, and, subsequently, Statistics Denmark randomly identified 115 577 age-matched female controls. TS women and their matched controls were linked with person-level data from the National Patient Registry and the Medication Statistics Registry, and they were compared concerning mortality, hospitalizations, and medical prescriptions. Among 329 45,X women, 44 had never been HRT treated, and 285 had been treated at some point. HRT treated women were compared with untreated concerning mortality, hospitalizations, and medical prescriptions. Results Endocrine and cardiovascular mortality and morbidity were significantly increased in TS compared with the matched controls. Comparing HRT treated with nontreated 45,X women, we found a similar mortality (hazard ratio 0.83, 95% confidence interval 0.38–1.79). Among the HRT-treated 45,X women, we found a significantly lower use of antihypertensives, antidiabetics, and thyroid hormones and significantly reduced hospitalization rates for stroke and osteoporotic fractures. Conclusion Women with TS have an increased overall mortality and morbidity. HRT seems to have a beneficial effect on endocrine conditions, hypertension, and stroke in women with 45,X karyotype, with no clear impact on mortality.

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Effects of Combined Estrogen and Progesterone on Brain Infarction in Reproductively Senescent Female Rats

Journal of Cerebral Blood Flow & Metabolism ◽

10.1097/01.wcb.0000135594.13576.d2 ◽

2004 ◽

Vol 24 (10) ◽

pp. 1160-1166 ◽

Cited By ~ 69

Author(s):

Thomas J. Toung ◽

Tsung-Ying Chen ◽

Marguerite T. Littleton-Kearney ◽

Patricia D. Hurn ◽

Stephanie J. Murphy

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Postmenopausal Women ◽

Brain Infarction ◽

Combined Therapy ◽

Hormone Replacement ◽

Treated Group ◽

Female Rats ◽

Female Rat ◽

Triphenyltetrazolium Chloride

Recent data from the Women's Health Initiative have highlighted many fundamental issues about the utility and safety of long-term estrogen use in women. Current hormone replacement therapy for postmenopausal women incorporates progestin with estrogen, but it is uncertain if combined therapy provides major cerebrovascular risks or benefits to these women. No experimental animal stroke studies have examined combined hormone administration. The authors tested the hypothesis that combined hormone treatment reduces ischemic injury in middle-aged female rat brain. Reproductively senescent female rats underwent 2-hour middle cerebral artery occlusion (MCAO) followed by 22 hours reperfusion. Estrogen implants were placed subcutaneously at least 7 days before MCAO, and progesterone intraperitoneal injections were given 30 minutes before MCAO, at initiation, and at 6 hours of reperfusion. Rats received no hormone, a 25-μg estrogen implant, a 25-μg estrogen implant plus 5 mg/kg intraperitoneal progesterone, or 5 mg/kg intraperitoneal progesterone. Cortical, caudoputamen, and total infarct volumes were assessed by 2,3,5-triphenyltetrazolium chloride staining and digital image analysis at 22 hours reperfusion. Cortical and total infarct volumes, except in the acute progesterone-treated group, were significantly attenuated in all estrogen-alone and combined hormone-treated groups. There were no significant differences in caudoputamen infarct volumes in all hormone-treated groups as compared with untreated rats. These data have potential clinical implications relative to stroke for postmenopausal women taking combined hormone replacement therapy.

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