Decision analysis of hormone replacement therapy after the Women's Health Initiative.
The purpose of this study was to estimate the quality-adjusted life expectancy with and without hormone replacement therapy. We compared the quality-adjusted life expectancy with and without combination hormone replacement therapy in three cohorts of women with menopausal symptoms over a 20-year period using a Markov decision-analysis model. Women were either at high or low risk for breast cancer and coronary heart disease or at high risk for osteoporosis. Hormone replacement therapy decreases life expectancy slightly compared with no hormone replacement therapy if menopausal symptoms are not considered. However, if relief from menopausal symptoms is considered and the usefulness of life with symptoms is worth <0.996 compared with life without symptoms, then 5 years of hormone replacement therapy provides equivalent quality-adjusted life-years. Combination hormone replacement therapy decreases life expectancy if quality of life with menopausal symptoms is not considered. However, the benefit of hormone replacement therapy can exceed the risk for women with menopausal symptoms.