Loading
Life sciences · Journal article
Obstetrics and Gynecology · August 13, 2026
Encouraging direction, but not yet definitive.
This Markov model-based cost-effectiveness analysis concludes that menopausal hormone therapy (MHT) is cost-effective and cost-saving compared to no MHT in hypothetical 50-year-old women with vasomotor symptoms followed for 5 years of use and a lifetime horizon. The results are driven primarily by reductions in atherosclerotic cardiovascular disease (ASCVD) risk, with modest increases in breast cancer offset by reductions in hip fractures and overall mortality. However, the analysis is model-based rather than empirical, and the magnitude and direction of clinical harms and benefits—particularly for breast cancer and ASCVD—remain uncertain in real populations.
Cost-effectiveness analysis using Markov decision model. Hypothetical 50-year-old women with vasomotor symptoms; stratified by uterine status (with or without uterus). Intervention: Menopausal hormone therapy: transdermal estradiol (E2) for women without a uterus; transdermal E2 plus micronized progesterone for women with a uterus; assumed 5 years of use. Compared with: No menopausal hormone therapy.
Transdermal E2 versus no MHT: $135,396,560 less expensive per 10,000 patients lifetime, 33,196 QALYs gained, 259 fewer ASCVD cases, 105 fewer colon cancer cases, 87 more breast cancer cases, 181 fewer hip fractures, 647 fewer deaths E2 + micronized progesterone versus no MHT: $127,738,990 less expensive per 10,000 patients lifetime, 33,083 QALYs gained, 285 fewer ASCVD cases, 18 more colon cancer cases, 46 more breast cancer cases, 183 fewer hip fractures, 615 fewer deaths Absolute dominance (cost-saving and health-improving) demonstrated for both MHT strategies at all willingness-to-pay thresholds up to $200,000 per QALY
Model assumes 5 years of MHT use; longer-term harms beyond this period are not quantified
If validated in prospective studies, these findings could support recommending MHT for eligible symptomatic women on both health and economic grounds. However, clinicians should recognize that the net benefit of MHT, particularly regarding breast cancer risk, remains contested in the clinical literature and varies substantially by individual patient characteristics, dose, formulation, and duration of use.
A decision-analytic model with sound methodology and clear results, but modelling studies do not directly measure clinical outcomes and depend heavily on input assumptions; findings require validation in prospective trials.
As stated by the source record.
Quoted from the source exactly as published.
If validated in prospective studies, these findings could support recommending MHT for eligible symptomatic women on both health and economic grounds. However, clinicians should recognize that the net benefit of MHT, particularly regarding breast cancer risk, remains contested in the clinical literature and varies substantially by individual patient characteristics, dose, formulation, and duration of use.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
OBJECTIVE: To evaluate the cost effectiveness of menopausal hormone therapy (MHT) based on the risk–benefit profiles of current MHT formulations. METHODS: We used a Markov model to examine the cost effectiveness of MHT for hypothetical 50-year-old women with vasomotor symptoms compared with transdermal estradiol (E2) alone for patients without a uterus and transdermal E2 in combination with micronized progesterone for patients with a uterus, assuming 5 years of use. Using a health system perspective, we expressed the effectiveness in quality-adjusted life years (QALYs), and the willingness-to-pay threshold was set to $100,000 per QALY gained. We derived probabilities, cost data, and utilities from the literature and estimated the incremental cost-effectiveness ratios between the MHT and no MHT strategies as our primary outcome. Secondary outcomes included the number of cases of cardiovascular disease, breast cancer, colon cancer, and hip fracture and the number of deaths. RESULTS: Use of MHT demonstrated absolute dominance over not using MHT for both the E2 and E2+micronized progesterone arms. Per 10,000 patients over a lifetime, E2 compared with no MHT was $135,396,560 less expensive, resulted in a gain of 33,196 QALYs, and was associated with 259 fewer cases of atherosclerotic cardiovascular disease (ASCVD), 105 fewer colon cancer cases, 87 more breast cancer cases, 181 fewer hip fractures, and 647 fewer deaths. Micronized progesterone compared with no MHT was $127,738,990 less expensive, resulted in a gain of 33,083 QALYs, and was associated with 285 fewer cases of ASCVD, 18 more colon cancer cases, 46 more breast cancer cases, 183 fewer hip fractures, and 615 fewer deaths. Sensitivity analysis showed that variables related to ASCVD had the most effect on the model. Probabilistic sensitivity analysis revealed absolute dominance for both MHT strategies at all willingness-to-pay thresholds up to $200,000. CONCLUSION: Our model suggests that MHT is cost effective for typical patients experiencing menopausal symptoms with initiation of MHT at age 50 years and use for 5 years. The reduction in ASCVD risk by MHT is the largest driver of cost effectiveness in the model.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.