Benefits and harms associated with hormone replacement therapy: clinical decision analysis

doi:10.1136/bmj.328.7436.371

BMJ 2004;328:371 (14 February), doi:10.1136/bmj.328.7436.371

Paper

Benefits and harms associated with hormone replacement therapy: clinical decision analysis

Cosetta Minelli, research associate in evidence synthesis¹, Keith R Abrams, professor of medical statistics¹, Alex J Sutton, lecturer in medical statistics¹, Nicola J Cooper, research fellow in health services research¹

¹ Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, Leicester LE1 6TP

Correspondence to: K R Abrams keith.abrams{at}le.ac.uk

Objective To evaluate harms and benefits associated with useof combined hormone replacement therapy (HRT) for five yearsin women with different baseline risks for breast cancer.

Design Probabilistic clinical decision analysis.

Setting Hypothetical population of white UK women aged 50 yearswith different baseline risks for breast cancer.

Main outcome measure Gain or loss in quality adjusted life years(QALYs).

Results Women free of menopausal symptoms showed a net harmfrom HRT use, which increased for increasing baseline risk ofbreast cancer. Those with a baseline risk of 1.2% would expecta loss in QALYs of 0.4 months (- 0.03 QALYs, 95% credibilityinterval - 0.05 to - 0.01). The main analysis showed HRT tobe on average beneficial in women with symptoms, with benefitdecreasing with increasing baseline risk of breast cancer. Theresults were sensitive to the assumed value of quality of lifewith menopausal symptoms, therefore a contour plot was developedto show the probability of net harm for a range of differentvalues and baseline risks.

Conclusions HRT for primary prevention of chronic diseases inwomen without menopausal symptoms is unjustified. Perceivedquality of life in women with symptoms should be taken intoaccount when deciding on HRT. Thus, a decision analysis tailoredto an individual woman is more appropriate in clinical practicethan a population based approach.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Abusing patients by denying them choice: Richard Smith
BMJ 2004 328: 0. [Extract] [Full Text] [PDF]

Where are we now with hormone replacement therapy?: Klim McPherson
BMJ 2004 328: 357-358. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Wildschut, H. I.J., Peters, T.J., Weiner, C. P. (2006). Screening in women's health, with emphasis on fetal Down's syndrome, breast cancer and osteoporosis. Hum Reprod Update 12: 499-512 [Abstract] [Full text]
McPherson, K. (2004). Where are we now with hormone replacement therapy?. BMJ 328: 357-358 [Full text]

Rapid Responses:

Read all Rapid Responses

HRT-Slow withdrawal or reduced dose may be necessitated: Parvaiz A Koul
bmj.com, 17 Feb 2004 [Full text]
HRT Addiction: Ellen C G Grant
bmj.com, 19 Feb 2004 [Full text]
How useful are net benefit decision models to individual women?: Jean Hodson, et al.
bmj.com, 22 Feb 2004 [Full text]
HRT and Periodontal Disease: Gregory S. Antonarakis
bmj.com, 22 Feb 2004 [Full text]
HRT: is the pendulum swinging?: Beverley A Lawton, et al.
bmj.com, 1 Jul 2004 [Full text]