Cost Effectiveness of Hormone Replacement Therapy for Fracture Prevention in Young Postmenopausal Women: An Economic Analysis Based on a Prospective Cohort Study

R. Fleurence, D. J. Torgerson, David M Reid

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

A recent systematic review of randomized controlled trials has shown that hormone replacement therapy (HRT) prevents fractures when taken soon after the menopause. HRT for treatment of menopausal symptoms is relatively cost-effective, but whether its use for prevention of perimenopausal fractures is economically efficient is unknown. We undertook a 6-year follow-up of 3645 perimenopausal women who had a bone mineral density (BMD) measurement with recommendation to use HRT if low BMD was present. Data were collected on incident fractures and costs. After an average of 6.2 years of follow-up HRT use significantly reduced incident fractures by 52% (95% Cl: 67% to 18%). However, costs were increased by an average of pound275 (95% Cl: 228 to 330) for the group as a whole; for hysterectomized women costs were increased less (pound138), but this was still significantly greater than for non-HRT users (95% Cl: pound6 to pound275). The cost per averted fracture was about pound11000 (95% Cl: pound8625 to pound13872) for the whole group and for hysterectomized women the corresponding figure was substantially less (pound1784; 95% Cl: pound59 to pound3532). HRT given to women at or shortly after the menopause is therefore associated with a halving of fracture incidence. Such a policy for hysterectomized women without menopausal symptoms may be cost-effective as such women are at elevated risk of fracture and need cheaper, unopposed, estrogens.

Original languageEnglish
Pages (from-to)637-643
Number of pages6
JournalOsteoporosis International
Volume13
Issue number8
DOIs
Publication statusPublished - Aug 2002

Keywords

  • economics
  • fractures
  • hormone replacement therapy
  • menopause
  • osteoporosis
  • BONE-MINERAL DENSITY
  • RANDOMIZED TRIAL
  • HIP FRACTURE
  • OSTEOPOROSIS
  • RISK
  • POPULATION

Cite this

Cost Effectiveness of Hormone Replacement Therapy for Fracture Prevention in Young Postmenopausal Women: An Economic Analysis Based on a Prospective Cohort Study. / Fleurence, R.; Torgerson, D. J.; Reid, David M.

In: Osteoporosis International, Vol. 13, No. 8, 08.2002, p. 637-643.

Research output: Contribution to journalArticle

@article{849be0b4ddca48ca80cf3830a7be5ec1,
title = "Cost Effectiveness of Hormone Replacement Therapy for Fracture Prevention in Young Postmenopausal Women: An Economic Analysis Based on a Prospective Cohort Study",
abstract = "A recent systematic review of randomized controlled trials has shown that hormone replacement therapy (HRT) prevents fractures when taken soon after the menopause. HRT for treatment of menopausal symptoms is relatively cost-effective, but whether its use for prevention of perimenopausal fractures is economically efficient is unknown. We undertook a 6-year follow-up of 3645 perimenopausal women who had a bone mineral density (BMD) measurement with recommendation to use HRT if low BMD was present. Data were collected on incident fractures and costs. After an average of 6.2 years of follow-up HRT use significantly reduced incident fractures by 52{\%} (95{\%} Cl: 67{\%} to 18{\%}). However, costs were increased by an average of pound275 (95{\%} Cl: 228 to 330) for the group as a whole; for hysterectomized women costs were increased less (pound138), but this was still significantly greater than for non-HRT users (95{\%} Cl: pound6 to pound275). The cost per averted fracture was about pound11000 (95{\%} Cl: pound8625 to pound13872) for the whole group and for hysterectomized women the corresponding figure was substantially less (pound1784; 95{\%} Cl: pound59 to pound3532). HRT given to women at or shortly after the menopause is therefore associated with a halving of fracture incidence. Such a policy for hysterectomized women without menopausal symptoms may be cost-effective as such women are at elevated risk of fracture and need cheaper, unopposed, estrogens.",
keywords = "economics, fractures, hormone replacement therapy, menopause, osteoporosis, BONE-MINERAL DENSITY, RANDOMIZED TRIAL, HIP FRACTURE, OSTEOPOROSIS, RISK, POPULATION",
author = "R. Fleurence and Torgerson, {D. J.} and Reid, {David M}",
year = "2002",
month = "8",
doi = "10.1007/s001980200086",
language = "English",
volume = "13",
pages = "637--643",
journal = "Osteoporosis International",
issn = "0937-941X",
publisher = "SPRINGER-VERLAG LONDON LTD",
number = "8",

}

TY - JOUR

T1 - Cost Effectiveness of Hormone Replacement Therapy for Fracture Prevention in Young Postmenopausal Women: An Economic Analysis Based on a Prospective Cohort Study

AU - Fleurence, R.

AU - Torgerson, D. J.

AU - Reid, David M

PY - 2002/8

Y1 - 2002/8

N2 - A recent systematic review of randomized controlled trials has shown that hormone replacement therapy (HRT) prevents fractures when taken soon after the menopause. HRT for treatment of menopausal symptoms is relatively cost-effective, but whether its use for prevention of perimenopausal fractures is economically efficient is unknown. We undertook a 6-year follow-up of 3645 perimenopausal women who had a bone mineral density (BMD) measurement with recommendation to use HRT if low BMD was present. Data were collected on incident fractures and costs. After an average of 6.2 years of follow-up HRT use significantly reduced incident fractures by 52% (95% Cl: 67% to 18%). However, costs were increased by an average of pound275 (95% Cl: 228 to 330) for the group as a whole; for hysterectomized women costs were increased less (pound138), but this was still significantly greater than for non-HRT users (95% Cl: pound6 to pound275). The cost per averted fracture was about pound11000 (95% Cl: pound8625 to pound13872) for the whole group and for hysterectomized women the corresponding figure was substantially less (pound1784; 95% Cl: pound59 to pound3532). HRT given to women at or shortly after the menopause is therefore associated with a halving of fracture incidence. Such a policy for hysterectomized women without menopausal symptoms may be cost-effective as such women are at elevated risk of fracture and need cheaper, unopposed, estrogens.

AB - A recent systematic review of randomized controlled trials has shown that hormone replacement therapy (HRT) prevents fractures when taken soon after the menopause. HRT for treatment of menopausal symptoms is relatively cost-effective, but whether its use for prevention of perimenopausal fractures is economically efficient is unknown. We undertook a 6-year follow-up of 3645 perimenopausal women who had a bone mineral density (BMD) measurement with recommendation to use HRT if low BMD was present. Data were collected on incident fractures and costs. After an average of 6.2 years of follow-up HRT use significantly reduced incident fractures by 52% (95% Cl: 67% to 18%). However, costs were increased by an average of pound275 (95% Cl: 228 to 330) for the group as a whole; for hysterectomized women costs were increased less (pound138), but this was still significantly greater than for non-HRT users (95% Cl: pound6 to pound275). The cost per averted fracture was about pound11000 (95% Cl: pound8625 to pound13872) for the whole group and for hysterectomized women the corresponding figure was substantially less (pound1784; 95% Cl: pound59 to pound3532). HRT given to women at or shortly after the menopause is therefore associated with a halving of fracture incidence. Such a policy for hysterectomized women without menopausal symptoms may be cost-effective as such women are at elevated risk of fracture and need cheaper, unopposed, estrogens.

KW - economics

KW - fractures

KW - hormone replacement therapy

KW - menopause

KW - osteoporosis

KW - BONE-MINERAL DENSITY

KW - RANDOMIZED TRIAL

KW - HIP FRACTURE

KW - OSTEOPOROSIS

KW - RISK

KW - POPULATION

U2 - 10.1007/s001980200086

DO - 10.1007/s001980200086

M3 - Article

VL - 13

SP - 637

EP - 643

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

IS - 8

ER -