A reassessment of the cost-effectiveness of hormone replacement therapy in Sweden – results based on the Women’s Health Initiative randomised controlled trial

The cost-effectiveness of hormone replacement therapy (HRT) based on a societal perspective is reassessed based on new medical evidence found in the Women’s Health Initiative (WHI). Within a model framework using an individual state transition model the cost-effectiveness of 50-60 year old women with menopausal symptoms is assessed in Sweden. The Markov model has a 50 year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: Coronary Heart Disease (CHD), Stroke, Venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture and wrist fracture. An intervention is modelled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality adjusted life years (QALYs) with and without intervention. The resulting cost per gained QALY is compared to the value of a gained QALY, which is set to SEK 600 000. The model requires data on clinical effects, risks, mortality rates, quality of life weights and costs valid for Sweden. The cost-effectiveness ratios are estimated at about SEK 10 000, which is far below the value of a gained QALY. Conditional on that HRT increases the quality of life weight more than 0.013 the therapy is cost-effective. In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.cost-effectiveness analysis; hormone replacement therapy; Markov model

A reassessment of the cost-effectiveness of hormone replacement therapy in Sweden: Results based on the Women's Health Initiative randomised controlled trial

The cost-effectiveness of hormone replacement therapy (HRT) based on a societal perspective is reassessed based on new medical evidence found in the Women's Health Initiative (WHI). Within a model framework using an individual state transition model the cost-effectiveness of 50-60 year old women with menopausal symptoms is assessed in Sweden. The Markov model has a 50 year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: Coronary Heart Disease (CHD), Stroke, Venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture and wrist fracture. An intervention is modelled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality adjusted life years (QALYs) with and without intervention. The resulting cost per gained QALY is compared to the value of a gained QALY, which is set to SEK 600 000. The model requires data on clinical effects, risks, mortality rates, quality of life weights and costs valid for Sweden. The cost-effectiveness ratios are estimated at about SEK 10 000, which is far below the value of a gained QALY. Conditional on that HRT increases the quality of life weight more than 0.013 the therapy is cost-effective. In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms

Costs and quality of life associated with osteoporosis related fractures - Results from a Swedish survey

There are few studies investigating the consequences of osteoporotic (low bone density) fractures in terms of costs and health outcomes. The purpose of this Swedish pilot study is to assess the costs and quality of life related to fractures of the hip, spine, wrist and shoulder and further to identify important cost items that should be included in future studies in this area. Data were collected using a questionnaire administered by a nurse at Malmö University Hospital. The costs are collected based on a societal perspective and include both direct and indirect costs. Health effects were measured by the EuroQol questionnaire, rating scale method and the SF-36. The total costs varied between SEK 23 000 for a wrist fracture and SEK 63 000 for a hip fracture. Although that the response rate is low the cost and quality of life related to hip fracture are close to the results presented in other studies. The major new finding is that spine fractures are associated with higher costs and lower quality of life than previously assumed. Future studies must include a sufficient number of patients in order to obtain reliable cost and health effect estimates after osteoporotic fractures in general and after spine fractures in particular. Such studies will provide important inputs for health economic evaluations assessing the cost-effectiveness of the treatment and prevention of osteoporosis.costs; fracture; osteoporosis; quality of life