The Women's Health Initiative Study: individualisation of hormone replacement therapy in a defined South African population

Abstract

Abstract Objective The aim of this study was to investigate the impact of the Women's Health Initiative (WHI) study on the prescribing of hormone replacement therapy (HRT) in a defined South African population and to establish whether patient therapy was appropriately individualised as a result of the WHI study. Setting Claims data from a South African managed healthcare organisation. Method A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined study groups. This analysis included determining discontinuation and initiation rates for HRT during selected 6-month periods. An investigation into patient demographics and prescribing patterns followed, whereby trends observed among patients either initiating or discontinuing HRT in the 6-month period post-WHI publication were contrasted with patients using HRT prior to publication of the WHI study. The prevalence of concomitant disease states among these subgroups was also assessed. Key findings The discontinuation rate for HRT following publication of the WHI study increased from 3.47% to 7.54%, while the initiation rate decreased from 15.34% to 9.10%. Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study), and were at a higher risk for disease states for which HRT use is considered harmful, such as diseases affecting the cardiovascular system. Conclusion It can be concluded that HRT was appropriately individualised according to recommendations based on the results of the WHI study in the defined populations of this study.