Cost-effectiveness of raloxifene and hormone replacement therapy in postmenopausal women: Impact of breast cancer risk

Objective: To examine the life expectancy and cost-effectiveness of hormone replacement therapy (HRT) and raloxifene therapy in healthy 50-year-old po stmenopausal women. Methods: We performed a cost-effectiveness analysis using a Markov model, d iscounting the value of future costs and benefits to account for their time of occurrence. Results: Both HRT and raloxifene therapy increase life expectancy and are c ost-effective relative to no therapy for 50-year-old postmenopausal women. For women at average breast cancer and coronary heart disease risk, lifetim e HRT increases quality-adjusted life expectancy more (1.75 versus 1.32 qua lity-adjusted life years) and costs less ($3802 versus $12,968) than lifeti me raloxifene therapy. However, raloxifene is more cost-effective than HRT for women at average coronary risk who have a lifetime breast cancer risk o f 15% or higher or who receive 10 years or less of postmenopausal therapy. Raloxifene is also the more cost-effective alternative if HRT reduces coron ary heart disease risk by less than 20%. Conclusions: Assuming the benefit of HRT in coronary heart disease preventi on from observational studies, longterm HRT is the most cost-effective alte rnative for women at average breast cancer and coronary heart disease risk seeking to extend their quality-adjusted life expectancy after menopause. H owever, raloxifene is the more cost-effective alternative for women at aver age coronary risk with one or more major breast cancer risk factors (first- degree relative, prior breast biopsy, atypical hyperplasia or BRCA1/2 mutat ion). These results can help inform decisions about postmenopausal therapy until the results of large scale randomized trials of these therapies becom e available. (Obstet Gynecol 2001;98:996-1003. (C) 2001 by the American Col lege of Obstetricians and Gynecologists.).