Cost-effectiveness of hormone replacement therapy for fracture prevention in young postmenopausal women: An economic analysis based on a prospective cohort study

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.