Abstract
BackgroundSeveral evaluations of the cost-effectiveness (CE) of menopausal hormone therapy (MHT) have been reported. The aim of this study was to systematically and critically review economic evaluations of MHT since 2002, after the Women’s Health Initiative (WHI) trial results on MHT were published.MethodsThe inclusion criteria for the review were: CE analyses of MHT versus no treatment, published from 2002-2016, in healthy women, which included both symptom relief outcomes and a range of longer term health outcomes (breast cancer, coronary heart disease, stroke, fractures and colorectal cancer). Included economic models had outcomes expressed in cost per quality-adjusted life year or cost per life year saved. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases and the Cost-Effectiveness Analysis Registry were searched. CE evaluations were assessed in regard to (i) reporting standards using the CHEERS checklist and Drummond checklist; (ii) data sources for the utility of MHT with respect to menopausal symptom relief; (iii) cost derivation; (iv) outcomes considered in the models; and (v) the comprehensiveness of the models with respect to factors related to MHT use that impact long term outcomes, using breast cancer as an example outcome.ResultsFive studies satisfying the inclusion criteria were identified which modelled cohorts of women aged 50 and older who used combination or estrogen-only MHT for 5-15 years. For women 50-60 years of age, all evaluations found MHT to be cost-effective and below the willingness-to-pay threshold of the country for which the analysis was conducted. However, 3 analyses based the quality of life (QOL) benefit for symptom relief on one small primary study. Examination of costing methods identified a need for further clarity in the methodology used to aggregate costs from sources. Using breast cancer as an example outcome, risks as measured in the WHI were used in the majority of evaluations. Apart from the type and duration of MHT use, other effect modifiers for breast cancer outcomes (for example body mass index) were not considered.ConclusionsThis systematic review identified issues which could impact the outcome of MHT CE analyses and the generalisability of their results. The estimated CE of MHT is driven largely by estimates of QOL improvements associated with symptom relief but data sources on these utility weights are limited. Future analyses should carefully consider data sources and the evidence on the long term risks of MHT use in terms of chronic disease. This review highlights the considerable difficulties in conducting cost-effectiveness analyses in situations where short term benefits of an intervention must be evaluated in the context of long term health outcomes.
Highlights
The explicit focus was on short-term menopausal hormone therapy (MHT) use (5 years or less) and on the comparison with other treatment alternatives for short term use and the scope was somewhat distinct from the included analyses in our review
Our findings must be interpreted in historical context with respect to the included studies - firstly, reporting standards for economic evaluations have improved over time and since the publication of the primary studies; and secondly, quantitative independent syntheses of the long term risks and benefits of MHT were not necessarily available at the time of some of the primary study analyses
Our findings must be interpreted in historical context with respect to the work presented in the included studies - firstly, reporting standards for economic evaluations have improved over time; and secondly, quantitative independent syntheses of the long term risk and benefits of MHT were not necessarily available at the time of some of the primary study analyses
Summary
Provide explicit statement of broader context, state study question & relevance for public policy or practice decisions incomplete incomplete incomplete incomplete incompleteTarget population: describe base case population & subgroups incomplete incomplete incomplete yes analysed including why they were chosen incompleteSetting and location: state relevant aspects of the system(s) in no no no which the decision(s) need(s) to be madeDescribe the study perspective & relate this to the costs evaluated yes incomplete yes incomplete incompleteDescribe the comparators and state why they were chosen incomplete incomplete incomplete yes incompleteState the time horizon(s) over which costs & consequences are incomplete incomplete incomplete incomplete incomplete evaluated & say why appropriateReport the choice of discount rate(s) used for costs & outcomes; say why appropriateDescribe choice of health outcomes & their relevance for the type incomplete yes yes yes of analysis performed incompleteDescribe fully the methods used for identification of included studies & synthesis of clinical effectiveness data incomplete incomplete incomplete incomplete incompleteDescribe the population & methods used to elicit preferences for outcomes incomplete incomplete incomplete incomplete incompleteDescribe approaches & data sources for estimating resource use; describe research methods for valuing resource items as unit cost. State the time horizon(s) over which costs & consequences are incomplete incomplete incomplete incomplete incomplete evaluated & say why appropriate. Several evaluations of the cost-effectiveness (CE) of menopausal hormone therapy (MHT) have been reported. To assess whether MHT is cost-effective in any group, benefits for quality of life need to be considered together with the health risks, and resources (costs) associated with use. The cost-effectiveness (CE) of any intervention can be summarised using a single measure known as the cost per Quality-Adjusted Life Years (QALY). This measure can be estimated using modelled evaluation of the benefits, costs, and any adverse health effects (short or long term) of the intervention. Ongoing evaluation of the CE of drugs that are widely used, ensures that optimal health investments continue to be made
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
