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Published on: August 13, 2019
Cost-Effectiveness Analysis of Menopausal Hormone Therapy
Elizabeth Gill1, Wu Zeng, Katerina Shvartsman
1Walter Reed National Military Medical Center and the Uniformed Services University of the Health Sciences, Bethesda, Maryland; and the Department of Global Health, Georgetown University, Washington, DC.
Obstetrics and Gynecology
|August 13, 2026
Summary
Menopausal hormone therapy (MHT) is cost-effective for women aged 50 experiencing menopausal symptoms. Using MHT for five years reduces costs and improves health outcomes, primarily by lowering cardiovascular disease risk.
Area of Science:
- Reproductive Endocrinology
- Health Economics
- Pharmacoeconomics
Background:
- Menopausal hormone therapy (MHT) is prescribed for symptom management.
- Current formulations offer varied risk-benefit profiles.
- Cost-effectiveness of MHT requires evaluation.
Purpose of the Study:
- To assess the cost-effectiveness of current menopausal hormone therapy (MHT) formulations.
- To analyze MHT based on risk-benefit profiles for women with vasomotor symptoms.
Main Methods:
- A Markov model simulated MHT use in 50-year-old women over a lifetime.
- Compared transdermal estradiol (E2) alone (no uterus) and E2 with micronized progesterone (uterus) against no MHT.
- Effectiveness measured in quality-adjusted life years (QALYs); willingness-to-pay threshold set at $100,000/QALY.
Main Results:
- Both MHT strategies demonstrated absolute dominance over no MHT.
- E2 therapy saved $135M and gained 33,196 QALYs per 10,000 patients.
- E2 with micronized progesterone saved $127M and gained 33,083 QALYs.
- MHT reduced cardiovascular disease, colon cancer, and hip fractures, despite a slight increase in breast cancer cases.
Conclusions:
- MHT is cost-effective for 50-year-old women with menopausal symptoms using it for 5 years.
- Reduced atherosclerotic cardiovascular disease (ASCVD) risk is the primary driver of MHT's cost-effectiveness.
- Probabilistic sensitivity analysis confirmed MHT's cost-effectiveness across various willingness-to-pay thresholds.
