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. 2020 Jun;27(6):632-639.
doi: 10.1097/GME.0000000000001517.

The Women's Health Initiative Estrogen-alone Trial had differential disease and medical expenditure consequences across age groups

Macarius M Donneyong  1   2 , Teng-Jen Chang  1 , Joshua A Roth  3 , McKenna Guilds  1 , Daniel Ankrah  1 , Mehdi Najafzadeh  4 , Wendy Y Xu  2 , Rowan T Chlebowski  5 , Karen Margolis  6 , JoAnn E Manson  7   8
Affiliations

The Women's Health Initiative Estrogen-alone Trial had differential disease and medical expenditure consequences across age groups

Macarius M Donneyong et al. Menopause. 2020 Jun.

Abstract

Objectives: The Women's Health Initiative (WHI) randomized trial identified age differences in the benefit-risk profile of estrogen-alone (ET) use. The impact of WHI trial on disease-associated medical expenditures attributable to subsequent decreased ET utilization has, however, not been measured. Therefore, the objective of this analysis was to quantify the age-specific disease-associated medical expenditures attributable to reduced ET utilization after the WHI Hormone Therapy (HT) trials.

Methods: Population-level disease counts and associated expenditures between 2003 and 2015 were compared between an observed ET-user population versus a hypothetical ET-user population assuming absence of the WHI HT trials, constructed by extrapolating ET utilization rates from 1996 to 2002 assuming pre-WHI HT rates would have continued without publication of the WHI HT trial data (2002-2004). Analyses were stratified by age (50-59, 60-69, and 70-79 years). Input data were extracted from Medical Expenditure Panel Survey and the literature. The primary outcomes were: ET utilization, chronic diseases (breast cancer, stroke, coronary heart disease, colorectal cancer, pulmonary embolism, and hip fracture) and disease-associated direct medical expenditures.

Results: Over 13 years, the decline in ET utilization was associated with $4.1 billion expenditure for excess chronic diseases (37,549 excess events) among women in their 50s, compared to savings of $1.5 billion and $4.4 billion for diseases averted by lower ET utilization among women in their 60s (13,495 fewer events) and 70s (40,792 fewer events), respectively.

Conclusion: The decline in ET utilization had differential disease and expenditure consequences by age groups in the United States. These results are limited by the lack of inclusion of vasomotor symptom benefit and costs of alternative medications for these symptoms in the analysis.

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Conflict of interest statement

Conflict of interest/financial disclosure: Dr. Chlebowski has received funding from Pfizer. Dr. Roth has received funding from Bayer. The other authors have no relevant disclosures.

Figures

Figure 1:
Figure 1:
Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy by age groups. Figure 1a: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 50–59 years old Figure 1b: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 60–69 years old Figure 1c: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 70–79 years old
Figure 1:
Figure 1:
Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy by age groups. Figure 1a: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 50–59 years old Figure 1b: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 60–69 years old Figure 1c: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 70–79 years old
Figure 1:
Figure 1:
Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy by age groups. Figure 1a: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 50–59 years old Figure 1b: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 60–69 years old Figure 1c: Temporal trends of prevalence of estrogen-alone utilization before and after publication of the WHI ET results among women with a history of hysterectomy aged 70–79 years old
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Comment in

References

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