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

ABSTRACT

Objectives: To investigate the cost-effectiveness of continuous combined hormone replacement therapy (ccHRT) (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 first-year 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 age-matched 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 €5000 throughout the nine calendar years examined and remained well below the threshold of acceptability of €50 000 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.

Key words: :

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