Cost-effectiveness of hormone replacement therapy in the menopause

Costs, risks, and benefits of estrogen-progestin therapy in the menopause were compared with those for estrogen alone, using techniques of cost-effectiveness analysis. With the progestin added, reduced costs of endometrial monitoring and treatment of endometrial lesions more than offset the increased cost of the drug regimen with a net saving of $230-$430 per patient, depending on the duration of treatment. An estimated gain in life expectancy with estrogen-progestin compared to estrogen alone may be partly offset by a perceived reduction in the quality of life owing to the prolongation of menstruation in women receiving progestin. Overall, based on currently available evidence, estrogen-progestin therapy appears to be cost-effective, except in women who consider the adverse effects of continued menstruation to offset the relief of menopausal symptoms. These conclusions must be viewed as tentative, pending further clarification of the roles of estrogens and progestins in cardiovascular disease and breast cancer.