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Title: Hormone Therapy Cost-effective for Perimenopausal Symptoms: Presented at NAMS

"Hormone Therapy Cost-effective for Perimenopausal Symptoms: Presented at NAMS"

By W. A. Thomasson Special to DG News CHICAGO, IL -- October 4, 2002 -- When quality of life is considered, combined estrogen-progestin hormone therapy (HT) is highly cost-effective for treatment of perimenopausal symptoms. The finding emerges from a study presented here October 3 at the annual meeting of the North American Menopause Society (NAMS). The poster, presented by Marc F. Botteman, MSc, of Herqules, Abt Clinical Trials in Bethesda, MD, and colleagues there and at Pfizer Pharmaceuticals, also concluded that the lower cost of the femhrt® brand rendered it more cost-effective than the rival Prempro™ brand. The study, which used values derived from the literature, assume a 5-year course of treatment with either femhrt, Prempro, or nothing beginning at age 50. Outcomes considered were full health, mild or severe menopausal symptoms, breakthrough bleeding, hip, wrist, or vertebral fractures, and death. Analysis of expected effects was continued beyond the end of treatment until the patient's death. Treatment effects were expressed as quality-adjusted life years (QALYs) gained, a procedure that treats decreased quality of life as equivalent to a shortening of life. Both active treatments provided an increase of 0.14 discounted QALYs, equivalent to 1.7 months of additional life. Costs were $1,265 for Prempro treatment and $696 for femhrt treatment, giving costs per QALY of $8957 and $4922, respectively. (The authors appear to have implicitly assumed that monitoring of therapy required no additional medical visits.) These costs per QALY are extremely modest compared to a number of commonly used therapies. Furthermore, although the numbers presented assume patients were fully compliant throughout the entire five years, sensitivity analysis showed that treatment remained highly cost-effective even if patients continued on therapy for an average of only one year and, furthermore, even if the value of osteoporosis prevention was excluded. It may also be noted that, since the study assumed limited-period treatment of a relatively young population in generally good cardiovascular health, results of the recent, widely reported Women's Health Initiative study would have had little effect on the results.

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