Daly E, Vessey M P, Barlow D, Gray A, McPherson K, Roche M
Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, UK.
Maturitas. 1996 Mar;23(2):247-59. doi: 10.1016/0378-5122(95)00978-7.
The relative cost-effectiveness of different treatment strategies for hormone replacement therapy (HRT) was assessed within the framework of a computer model. Where data were lacking, it was necessary to make assumptions about the effects of HRT, particularly in relation to combined oestrogen-progestogen therapy and cardiovascular disease; however, sensitivity analyses were performed to assess the impact of changing these assumptions on the cost-effectiveness equation. It appears that net expenditure by the NHS will depend critically on the direct costs of treatment, rather than on any indirect costs incurred or saved as a result of side-effects. In terms of mortality, a reduction in cardiovascular disease risk would have greatest impact and would overshadow any small increase in breast cancer risk which may be associated with long-term use. If the cardioprotective effect of oestrogen is real, our results suggest that long-term prophylactic treatment of hysterectomised women would be relatively cost-effective. Treatment of symptomatic menopausal women for any period of time appears to offer very good value for money. The lack of data relating to combined oestrogen-progestogen therapy and cardioprotection, and the major importance of the latter in the equation of benefits and risks, make it more difficult to draw conclusions about the cost-effectiveness of treating non-hysterectomised asymptomatic women for prophylactic reasons.
在计算机模型框架内评估了激素替代疗法（HRT）不同治疗策略的相对成本效益。在缺乏数据的情况下，有必要对HRT的效果进行假设，尤其是与雌激素 - 孕激素联合疗法和心血管疾病相关的效果；然而，进行了敏感性分析以评估改变这些假设对成本效益等式的影响。国民保健制度（NHS）的净支出似乎将主要取决于治疗的直接成本，而非因副作用产生或节省的任何间接成本。就死亡率而言，降低心血管疾病风险的影响最大，并且会掩盖因长期使用可能导致的乳腺癌风险的任何小幅增加。如果雌激素的心脏保护作用是真实的，我们的结果表明，对子宫切除术后妇女进行长期预防性治疗将具有相对成本效益。对有症状的更年期妇女进行任何时间段的治疗似乎都具有很高的性价比。由于缺乏与雌激素 - 孕激素联合疗法和心脏保护相关的数据，以及后者在利益和风险等式中的重要性，使得难以就出于预防性原因治疗未切除子宫的无症状妇女的成本效益得出结论。
