Daly E, Roche M, Barlow D, Gray A, McPherson K, Vessey M
Department of Public Health & Primary Care, University of Oxford, UK.
Br Med Bull. 1992 Apr;48(2):368-400. doi: 10.1093/oxfordjournals.bmb.a072552.
A cost-effectiveness analysis of hormone replacement therapy (HRT) was undertaken to assess the relative benefits of different treatment strategies, and to identify which factors most influence cost-effectiveness. The current lack of conclusive evidence on the effects of HRT, especially in relation to combined therapy and cardiovascular disease, necessitated the use of a large number of assumptions in our model. In terms of net health benefits, the potential reduction in cardiovascular disease would have greatest impact, and would overshadow any small increase in breast cancer risk possibly associated with long-term use. Net expenditure by the NHS will depend critically on the direct costs of treatment, rather than on any indirect costs incurred or averted as a result of side-effects. In terms of cost-effectiveness, long-term prophylactic treatment of hysterectomised women and treatment of symptomatic women with a uterus compare favourably with other accepted health care interventions.
开展了一项激素替代疗法（HRT）的成本效益分析，以评估不同治疗策略的相对益处，并确定哪些因素对成本效益影响最大。目前缺乏关于HRT效果的确凿证据，尤其是与联合疗法和心血管疾病相关的证据，这使得我们在模型中不得不使用大量假设。就净健康效益而言，心血管疾病的潜在减少将产生最大影响，并且会掩盖长期使用可能导致的乳腺癌风险的任何小幅增加。英国国家医疗服务体系（NHS）的净支出将在很大程度上取决于治疗的直接成本，而非因副作用产生或避免的任何间接成本。就成本效益而言，对子宫切除妇女的长期预防性治疗以及对有子宫的症状性妇女的治疗，与其他公认的医疗保健干预措施相比具有优势。
