The pharmacoeconomics of hormone replacement therapy
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Updated: Oct 9, 2026
Combining Behavioral Endocrinology and Experimental Economics: Testosterone and Social Decision Making
Published on: March 2, 2011
1Department of Health Studies, University of York, England. djt6@york.ac.uk
Insights
Hormone replacement therapy (HRT) is cost-effective for menopausal symptoms but may not prevent cardiovascular disease. Its increased breast cancer risk makes it less cost-effective for asymptomatic women, suggesting targeted use for osteoporosis prevention.
Area of Science:
- Reproductive Endocrinology
- Pharmacoeconomics
- Oncology
Background:
- Hormone replacement therapy (HRT) is established as a cost-effective treatment for menopausal symptoms like hot flashes.
- Previous economic evaluations suggested HRT's cost-effectiveness for cardiovascular disease (CVD) prevention and osteoporosis.
- Recent evidence questions HRT's efficacy in CVD prevention, particularly secondary prevention, and highlights an increased breast cancer risk.
Purpose of the Study:
- To re-evaluate the cost-effectiveness of HRT in light of new evidence regarding its cardiovascular and breast cancer effects.
- To assess the cost-effectiveness of HRT for asymptomatic women at low risk of osteoporosis.
- To explore targeted HRT strategies for women with low bone mass and fracture risk.
Main Methods:
- Economic evaluation of HRT based on updated evidence for cardiovascular disease and breast cancer incidence.
- Comparative analysis of HRT strategies: general use versus targeted therapy for osteoporosis.
- Assessment of selective estrogen receptor modulators (SERMs) as alternatives.
Main Results:
- HRT's effectiveness in preventing cardiovascular disease is now considered slight or nonexistent, challenging prior assumptions.
- HRT is associated with a potential increase in breast cancer incidence.
- Targeting HRT to women with low bone mass and fracture risk may mitigate adverse effects and improve cost-effectiveness compared to long-term use in asymptomatic women.
Conclusions:
- HRT is unlikely to be cost-effective for asymptomatic, low-risk women due to uncertain cardiovascular benefits and increased breast cancer risk.
- Targeted HRT for women with specific osteoporosis risk factors presents a more cost-effective approach.
- Selective estrogen receptor modulators (SERMs) are unlikely to replace HRT for menopausal symptom management but may compete with bisphosphonates.
Abstract:
Hormone replacement therapy (HRT) is a highly cost-effective treatment for symptoms of the menopause such as hot flushes (flashes). A number of economic evaluations have indicated that it may also be a cost-effective therapy for the prevention of cardiovascular disease and osteoporosis. However, these evaluations are based on the premise that HRT will reduce cardiovascular disease by 30 to 50%. Recent evidence casts doubt on its effectiveness at preventing cardiovascular disease, certainly as a secondary preventive therapy. Furthermore, HRT is likely to increase the incidence of breast cancer. If the effect of HRT on the cardiovascular system is slight or nonexistent, but its effect on breast cancer is modest or strong, then HRT is unlikely to be a cost-effective treatment for asymptomatic women at low risk of osteoporosis. However, the unwanted effects of HRT on the breast may be significantly reduced by targeting therapy to those women with low bone mass and who have other risk factors for fracture. Such a strategy is likely to be more cost effective than a strategy which allows asymptomatic women with low fracture risk to take HRT in the long term. As selective estrogen receptor modulators (SERMs) aggravate menopausal symptoms they are not likely to be an alternative for most perimenopausal women. Therefore, SERMs are more likely to be a competitor to existing and forthcoming bisphosphonates rather than HRT.
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