COST-EFFECTIVENESS ANALYSIS OF HORMONE REPLACEMENT THERAPY FOR MENOPAUSAL WOMEN IN SERBIA

Abstract

Background/aim: Nowadays, in the develo­ped countries women may expect to spend at le­ast one-third of their lives beyond menopause. Natural menopause usually occurs at the age of 51 years, and it is characterized with unpleasant symptoms due to estrogen deficit in about 75% of cases. The aim of this study was to determine cost/effectiveness ratio of the hormone replace­ment therapy and to compare it with the same ratio for no-treatment alternative in Republic of Serbia.

Methods: A Markov decision  model was designed using TreeAge software (TreeAge Soft-ware Inc, USA) based on the literature data about the effectiveness and on local Serbia cost calculation, with prices taken  from RFHI Tariff Book (Republic Fund for Health Insurance). Women after hysterectomy were assigned to es­trogen substitution, whereas those with intact uterus were on combined (estrogen + progestin) therapy. The duration of one cycle was set at one year and the study time horizon covered 40 cycles i.e. a 40 years period. Monte Carlo simu­lation with 1000 hypothetical patients and addi­tional sensitivity analysis with Tornado diagram (varying the variables by ±50%) were performed.

Results: The results indicate that it is probably cost-effective to treat women after hysterectomy with hormone replacement therapy in Serbia, despite almost five times higher costs of the estrogen therapy per one quality adjusted life year gained. Hormone replacement therapy for menopausal women with intact uterus is not cost-effective; it is more expensive and less effec­tive.

Conclusion: This study shows that in Serbia hormone replacement therapy seems to be cost-effective treatment option for symptomatic po­stmenopausal women after hysterectomy as oppo­sed to it is use in postmenopausal women with intact uterus.