Please use this identifier to cite or link to this item:
Title: Benefits and harms associated with hormone replacement therapy: clinical decision analysis
Authors: Minelli, Cosetta
Abrams, Keith R.
Sutton, Alex J.
Cooper, Nicola J.
First Published: 14-Feb-2004
Publisher: BMJ Publishing Group
Citation: BMJ, 2004, 328, pp. 371-376
Abstract: Objective: To evaluate harms and benefits associated with use of combined hormone replacement therapy (HRT) for five years in women with different baseline risks for breast cancer. Design: Probabilistic clinical decision analysis. Setting: Hypothetical population of white UK women aged 50 years with 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 harm from HRT use, which increased for increasing baseline risk of breast cancer. Those with a baseline risk of 1.2% would expect a loss in QALYs of 0.4 months (- 0.03 QALYs, 95% credibility interval - 0.05 to - 0.01). The main analysis showed HRT to be on average beneficial in women with symptoms, with benefit decreasing with increasing baseline risk of breast cancer. The results were sensitive to the assumed value of quality of life with menopausal symptoms, therefore a contour plot was developed to show the probability of net harm for a range of different values and baseline risks. Conclusions: HRT for primary prevention of chronic diseases in women without menopausal symptoms is unjustified. Perceived quality of life in women with symptoms should be taken into account when deciding on HRT. Thus, a decision analysis tailored to an individual woman is more appropriate in clinical practice than a population based approach.
DOI Link: 10.1136/bmj.328.7436.371
ISSN: 0959-8138
Version: Published version
Status: Peer reviewed
Type: Article
Rights: © 2004 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License (
Appears in Collections:Published Articles, Dept. of Health Sciences

Files in This Item:
File Description SizeFormat 
371.pdf283 kBAdobe PDFView/Open

Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.