Menopausal hormone therapy (MHT) may reduce lifetime healthcare costs and improve health outcomes for symptomatic women who begin treatment at age 50, according to a new cost-effectiveness analysis published in Obstetrics & Gynecology.

“Patients are certainly concerned about the immediate symptoms that they’re having and their quality of life,” said Jill Brown, MD, MPH, professor in the Department of Gynecologic Surgery and Obstetrics at Uniformed Services University of the Health Sciences in Bethesda, Maryland, who led the study. “But they are also thinking about their long-term health, their bones, their cardiovascular disease risk, and all of that should be part of the discussion.”

In the modeling study, both transdermal estradiol alone and transdermal estradiol combined with micronized progesterone reduced costs and produced more quality-adjusted life-years (QALYs) than no MHT. The reduction in atherosclerotic cardiovascular disease (ASCVD) risk associated with MHT was the largest driver of the findings.

The research comes amid renewed interest in MHT after prescribing declined sharply following the 2002 Women’s Health Initiative. Subsequent research has suggested that the benefits and risks vary according to factors including when treatment is initiated and the formulation and route of administration.

“The article echoes what is being said in current circles of women’s health: HRT [hormone replacement therapy] has many benefits that are greater than the risks, and women should not be denied this therapy,” said Janis Fee, MD, chair of the Department of Obstetrics and Gynecology at Providence St. Joseph Hospital Orange in Orange California.

Researchers modeled the lifetime health outcomes and healthcare costs of hypothetical 50-year-old women with vasomotor symptoms and no contraindications to MHT. They compared no MHT with 5 years of transdermal estradiol alone for women without a uterus or transdermal estradiol plus micronized progesterone for women with a uterus. The model incorporated published estimates of medication and healthcare costs, quality of life, and risks for ASCVD, breast and colon cancer, hip fracture, and death.

Both MHT strategies reduced healthcare costs and improved outcomes. At the individual level, estradiol alone was approximately $13,540 less expensive than no MHT, whereas estradiol plus micronized progesterone was approximately $12,773 less expensive. Both strategies produced approximately 3.3 additional QALYs over a lifetime.

For every 10,000 hypothetical women, estradiol alone was associated with approximately $135.4 million in savings and 33,196 additional QALYs compared with no MHT. It was also associated with 259 fewer ASCVD cases, 105 fewer colon cancer cases, 181 fewer hip fractures, and 647 fewer deaths but 87 additional breast cancer cases.

Estradiol plus micronized progesterone resulted in approximately $127.7 million in savings and 33,083 additional QALYs per 10,000 women, along with 285 fewer ASCVD cases, 183 fewer hip fractures, and 615 fewer deaths. The model produced 46 additional breast cancer cases and 18 additional colon cancer cases in this group.

The model may also underestimate MHT’s quality-of-life benefits, Brown said. Researchers accounted for improvements in vasomotor symptoms but not potential benefits involving sleep, cognitive function, or joint pain because evidence for those outcomes is less well established.

While the model projected more breast cancer cases with both MHT strategies, the model assumed no increased breast cancer risk from estradiol plus micronized progesterone. The researchers attributed the difference to longer survival rather than an increased breast cancer risk from MHT.

The findings rest heavily on assumptions about cardiovascular disease and mortality. Researchers assumed a 48% reduction in ASCVD risk during MHT use, as well as ongoing cardiovascular and mortality benefits after treatment ended. The results favored no MHT when the modeled probability of ASCVD with MHT exceeded 8.8% or when the probability of death exceeded 5.1% with estradiol alone or 4.8% with estradiol plus micronized progesterone. The authors noted that these thresholds exceeded the likely risks associated with MHT.

The cardiovascular risk estimates used in the model were partly based on studies that included oral formulations, which may carry greater cardiovascular risks than the transdermal formulations evaluated in the analysis, Brown said.

When researchers varied all model inputs simultaneously, both MHT strategies remained less costly and more effective than no MHT in 100% of 10,000 simulations.

“HRT is not only okay; it is of such health benefit that it should be offered, since it significantly reduces, not increases, several risks for women,” Fee said.

Brittany Vargas is a journalist covering medicine, mental health, and wellness.