Gorsky R D, Koplan J P, Peterson H B, Thacker S B
Department of Health Management and Policy, University of New Hampshire, Durham.
Obstet Gynecol. 1994 Feb;83(2):161-6.
To evaluate the relative risks and benefits of exogenous estrogen use among women entering the climacteric and to consider estrogen use for relief of symptoms or prevention of disease.
Decision analysis was used to assess the value of estrogen replacement therapy in a hypothetical cohort of 10,000 women assumed to be age 50 years; health outcomes were extrapolated to age 75. Risk ratios for mortality and morbidity of health outcomes associated with the use of estrogen replacement therapy were based on longitudinal studies reported in the literature.
Estrogen use for 25 years would decrease fatal coronary heart disease events by 48% (567 cases), decrease deaths from hip fracture by 49% (75), increase deaths from breast cancer by 21% (39), and increase deaths from endometrial cancer by 207% (29 excess deaths). On balance, 25 years of estrogen replacement therapy in a cohort of 10,000 women would prevent 574 deaths. Further, women using estrogens for 25 years would gain 3951 quality-adjusted life years compared with women not using estrogens. Sensitivity analysis suggests that the benefits of estrogen replacement therapy outweight the risks under most assumptions.
In a hypothetical, population-based analysis, the health benefits of postmenopausal estrogen replacement exceed the health risks incurred. Nevertheless, clinicians must still evaluate each individual's risks and needs.
评估进入更年期的女性使用外源性雌激素的相对风险和益处，并考虑使用雌激素来缓解症状或预防疾病。
采用决策分析方法评估在假设的10000名50岁女性队列中雌激素替代疗法的价值；健康结局外推至75岁。与使用雌激素替代疗法相关的健康结局的死亡率和发病率风险比基于文献报道的纵向研究。
使用雌激素25年可使致命性冠心病事件减少48%（567例），髋部骨折死亡减少49%（75例），乳腺癌死亡增加21%（39例），子宫内膜癌死亡增加207%（额外死亡29例）。总体而言，在10000名女性队列中进行25年的雌激素替代疗法可预防574例死亡。此外，与未使用雌激素的女性相比，使用雌激素25年的女性将获得3951个质量调整生命年。敏感性分析表明，在大多数假设下，雌激素替代疗法的益处超过风险。
在一项基于人群的假设分析中，绝经后雌激素替代疗法的健康益处超过了所带来的健康风险。然而，临床医生仍必须评估每个个体的风险和需求。
