The cost-effectiveness of hormone replacement therapy: a review

The use of postmenopausal hormone replacement therapy (HRT) has received much attention both in the medical and lay press in recent years. There is considerable pressure to extend the use of HRT both as a method for relieving the distressing symptoms of menopause and also as a prophylactic measure to prevent osteoporosis and subsequent bone fractures in high risk women. This paper critically reviews the available evidence on the risks and benefits of HRT use, focusing in particular on symptom relief, osteoporosis, breast cancer, endometrial cancer and heart disease. It goes on to consider whether the use of HRT is cost effective in terms of the resources used in the provision of the therapy and possible resource effects associated with the risks and benefits outlined above. Finally, whilst concluding that on balance some forms of HRT for certain women do indeed appear to be cost effective in the basis of available evidence, there are several major gaps in the information required to make firm conclusions. These are outlined, and priorities for future work are indicated.