Background
Methods
Search strategy, eligibility criteria and article selection
Assessment of data sources for MHT-related utility
Assessment of costing methods used in primary studies
Assessment of particular health outcomes included in economic models
Assessment of the comprehensiveness of the models
Ethics approval
Results
Selection of studies
Summary characteristics
Author year | Country | Perspective | Time horizon | MHT duration base-case | MHT type | Discount Rate (%) | Year of costs | Cost per QALY | CE? | CIF? |
---|---|---|---|---|---|---|---|---|---|---|
Salpeter et al. 2009 [41] | USA | Societal | lifetime | 15 years | E + P&E (pooled data) | 3 | 2006 | Age 50: $2,438; | Yes | Yes |
Age 65: $27,953 | No | Yes | ||||||||
Lekander et al. 2009 [42] | UK | Health care | 50 years | 5 years | E + P(+U) E(-U) | 3 | 2006 | Age 50: | Yes | |
£580(+U)a
| Yes | |||||||||
£205(-U)a
| Yes | |||||||||
Lekander et al. 2009 [43] | USA | Societal | 50 years | 5 years | E + P(+U) E(-U) | 3 | 2006 | Age 50: | Yes | |
$2,803(+U) | Yes | |||||||||
$295(- U) | Yes | |||||||||
Ylikangas et al. 2007 [44] | Finland | Health care | 9 years | 9 years | E + P(+U) | 3 | 2003/2004 | Age 50–70: | Yes | |
€2,996(+U) | Yes | |||||||||
(≤5 y MHT); | ||||||||||
€4613(+U) | Yes | |||||||||
(≤9 y MHT); | ||||||||||
Zethraeus et a.l 2005 [45] | Sweden | Societal | 50 years | 5 years | E + P(+) E(-U) | 3 | 2003 | Age 50: | Yes | |
SEK 12,807 (+U) | Yes | |||||||||
SEK 8,266(- U); | Yes | |||||||||
Age 55: | Yes | |||||||||
SEK 10,844 (+U) | Yes | |||||||||
SEK 7,960(- U); | Yes | |||||||||
Age 60: | Yes | |||||||||
SEK 9,159(+U) | Yes | |||||||||
SEK 11,043(-U); | Yes |
Item No | Sectiona
| Salpeter et al. 2009 [41] | Lekander et al. 2009a [42] | Lekander et al. 2009b [43] | Ylinkangas et al. 2007 [44] | Zethraeus et al. 2005 [45] |
---|---|---|---|---|---|---|
Title and abstract | ||||||
1 | In title identify study as an economic evaluation, or use relevant terms & describe interventions compared | incomplete | incomplete | incomplete | incomplete | incomplete |
2 | Provide structured summary in the abstract with specified subheadings | incomplete | incomplete | incomplete | incomplete | incomplete |
Introduction | ||||||
3 | Provide explicit statement of broader context, state study question & relevance for public policy or practice decisions | incomplete | incomplete | incomplete | incomplete | incomplete |
Methods | ||||||
4 | Target population: describe base case population & subgroups analysed including why they were chosen | incomplete | incomplete | incomplete | yes | incomplete |
5 | Setting and location: state relevant aspects of the system(s) in which the decision(s) need(s) to be made | no | no | no | no | no |
6 | Describe the study perspective & relate this to the costs evaluated | yes | incomplete | yes | incomplete | incomplete |
7 | Describe the comparators and state why they were chosen | incomplete | incomplete | incomplete | yes | incomplete |
8 | State the time horizon(s) over which costs & consequences are evaluated & say why appropriate | incomplete | incomplete | incomplete | incomplete | incomplete |
9 | Report the choice of discount rate(s) used for costs & outcomes; say why appropriate | incomplete | incomplete | incomplete | incomplete | incomplete |
10 | Describe choice of health outcomes & their relevance for the type of analysis performed | incomplete | yes | yes | yes | incomplete |
11 | Describe fully the methods used for identification of included studies & synthesis of clinical effectiveness data | incomplete | incomplete | incomplete | incomplete | incomplete |
12 | Describe the population & methods used to elicit preferences for outcomes | incomplete | incomplete | incomplete | incomplete | incomplete |
13 | Describe approaches & data sources for estimating resource use; describe research methods for valuing resource items as unit cost | incomplete | incomplete | incomplete | incomplete | incomplete |
14 | Give dates of est resource quantities & unit costs, methods for adjusting unit costs to year of reported costs & details regarding conversion to common currency base & exchange rate | incomplete | incomplete | incomplete | no | incomplete |
15 | Describe choice of model & reason for use. Provide figure of model structure. | yes | incomplete | yes | not applicable | incomplete |
16 | Describe all structural or other assumptions underpinning the decision-analytical model | yes | yes | yes | yes | yes |
17 | Describe methods for dealing with data issues, pooling data, extrapolation, model validation/adjustments & uncertainty | Incomplete | incomplete | incomplete | incomplete | incomplete |
Results | ||||||
18 | Report values, ranges, references & probability distributions for all parameters & reasons/sources for distributions used for uncertainty | yes | incomplete | incomplete | incomplete | incomplete |
19 | For each intervention report mean values for estimated costs & outcomes, mean comparator differences & if applicable ICERs | yes | incomplete | incomplete | incomplete | yes |
20 | Describe uncertainty effect for parameters & uncertainty in relation to model structure and assumptions | incomplete | incomplete | incomplete | incomplete | incomplete |
21 | Describe effect of heterogeneities on cost, outcome or CE | yes | yes | yes | incomplete | yes |
Discussions | ||||||
22 | Summarise findings, how they support conclusions, fit with current knowledge & their generalisability. Describe limitations | incomplete | incomplete | incomplete | incomplete | incomplete |
Other | ||||||
23 | Describe sources of funding, role of funder & any other non-monetary sources of support | Yes | incomplete | incomplete | incomplete | incomplete |
24 | Describe potential for conflict of interest as per journal policy or as per recommendations of International Committee of Med Journal Editors | yes | yes | yes | yes | yes |
Economic evaluation | ||||||
---|---|---|---|---|---|---|
Quality assessment parameter | Salpeter et al. 2009 [41] | Lekander et al. 2009a [42] | Lekander et al. 2009b [43] | Ylinkangas et al. 2007 [44] | Zethraeus et al. 2005 [45] | |
Study Design | Was the research question stated? | Yes | Yes | Yes | Yes | Yes |
Was the economic importance of the research question stated? | No | Partially | Partially | Yes | Partially | |
Was the viewpoint of the analysis clearly stated and justified? | Yes, but not justified | Yes, but not justified | Yes, but not justified | Not clearly stated, not justified | Yes, but not justified | |
Was a rationale reported for the choice of the alternative programmes or interventions compared? | N/A | N/A | N/A | N/A | N/A | |
Were the alternatives being compared clearly described? | Yes | Yes | Yes | Yes | Yes | |
Was the form of economic evaluation stated? | Yes | Yes | Yes | No | Yes | |
Was the choice of form of economic evaluation justified in relation to the questions addressed? | No | Yes | Yes | No | Yes | |
Data Collection | Were the sources of effectiveness estimates used stated? | Yes | Yes | Yes | Yes | Yes |
Were details of the design and results of the effectiveness study given? | Yes | Yes | Yes | Yes | Yes | |
Were the primary outcome measures for the economic evaluation clearly stated? | Yes | Yes | Yes | Yes | Yes | |
Were the methods used to value health states and other benefits stated? | No | Yes | Yes | Partially | No | |
Were the details of the subjects from whom valuations were obtained given? | No | No | No | Partially (only age) | No | |
Were productivity changes (if included) reported separately? | Not stated | N/A | Not stated | N/A | Not stated | |
Was the relevance of productivity changes to the study question discussed? | No | N/A | No | N/A | No | |
Were quantities of resources reported separately from their unit cost? | No | No | No | No | No | |
Were the methods for the estimation of quantities and unit costs described? | No | No | No | No | No | |
Were currency and price data recoded? | Yes (aggregate prices) | Yes (aggregate prices) | Yes (aggregate prices) | Yes (aggregate prices) | Currency yes; price data only for MHT | |
Were details of price adjustments for inflation or currency conversion given? | Yes, for inflation. Prices from other countries used. No, for currency conversion | Yes, for inflation. No other currency used | Yes, for inflation. Prices from other countries used. No, for currency conversion | No | Yes, for inflation. No other currency used | |
Were details of any model used given? | Yes | Yes | Yes | N/A | Yes | |
Was there justification for the choice of model used and the key parameters on which it was based? | Yes for model. Partially for parameters | Partially for model & for parameters | Yes for model. Partially for parameters | N/A | Partially for the model. Yes for parameters | |
Analysis & Interpretation | Was time horizon of cost and benefits stated? | Yes | Yes | Yes | Yes | Yes |
Was the discount rate stated? | Yes | Yes | Yes | Yes | Yes | |
Was the choice of rate justified? | No | No | No | No | No | |
Was an explanation given if cost or benefits were not discounted? | Both were discounted | Both were discounted | Both were discounted | No, benefits not discounted | Not clear what was discounted | |
Were the details of statistical tests and confidence intervals given for stochastic data? | Standard deviations given for QALYs | No | No | No | No | |
Was the approach to sensitivity analysis described? | Yes | Yes | Yes | Yes | Yes | |
Was the choice of variables for sensitivity analysis described? | Yes | Yes | Yes | Yes | listed only in results table | |
Were the ranges over which the parameters were varied stated? | Yes | Yes | Yes | Yes | Yes | |
Were relevant alternatives compared? | Yes | Yes | Yes | Yes | Yes | |
Was an incremental analysis reported? | Yes | Yes | Yes | Yes | Yes | |
Were major outcomes presented in a disaggregated as well as aggregated form? | Yes | No | No | No | Yes | |
Was the answer to the study question given? | Yes | Yes | Yes | Yes | Yes | |
Did conclusions follow from the data reported? | Yes | Yes | Yes | Yes | Yes | |
Were conclusions accompanied by the appropriate caveats | Partially | Partially | Partially | Partially | Partially | |
Were generalisability issues addressed? | Partially | Partially | Partially | Partially | Partially |
Data sources for MHT-related utility
Summary of costing methods and other costing issues
MHT health related outcomes
MHT-related health outcomes |
Publications
| ||||
---|---|---|---|---|---|
Salpeter et al. 2009 [41] |
Lekander et al. 2009a [42] |
Lekander et al. 2009b [43] |
Ylikangas et al. 2007 [44] |
Zethraeus et al. 2005 [45] | |
Breast Cancer | WHI (2002, 2004); meta-analysis of studies (2000, 2002); Cochrane database systematic review, 2005; HERS, 1998; MWS, 2003; Collabo-rative reanalysis of data on MHT and breast cancer, 1997; follow-up data from BCDDP, 2000; Danish cohort study, 2004; meta-analysis of WHI + HERS + WEST, 2002; | WHI (2003, 2006) | WHI (2002, 2004) | Events from intervention study: 279/ 419 women allocated to 3 of 4 dose combinations of EV&MA | WHI (2002, 2004) |
Colorectal Cancer | WHI (2002, 2004); review of studies, 2002; meta-analysis of WHI & HERS 2002; CPS-II, 1995; pooled RR from HERS I, II&WHI, 2004; meta-analysis of studies, 1999 | Two WHI study publications (2004) | WHI (2002, 2004) | Events from intervention study (see above) | WHI (2002, 2004) |
Coronary Heart Disease (CHD) | Cardiovascular events presented rather than CHD: NHS (2001, 2002); WHI (2002,2003, 2004, 2006, 2007); meta-analyses (1991, 2000, 2002, 2004, 2005); case control study 1991-1994, HERS,1998; | WHI (2007) | WHI (2002, 2004) | Events from study (see above) | WHI (2002, 2004) |
Deep vein thrombosis (DVT) | Not included | Included under VTD | Included under VTD | Events from study (see above) | Included under VTD |
Dementia | Not included | Not included | Not included | Not included | Not included |
Endometrial Cancer | Not applicable | Not applicable | Not applicable | Not specified but events from the study possibly included | Not applicable |
Fractures (hip, vertebral and other osteoporotic) | WHI (2002,2006); Cochrane systematic review, 2005; Danish osteoporosis prevention study, 2000; literature review, 2001; New Zealand study assessing bone density and factors determining bone loss, 2002; Danish study on MHT effect on fractures, 2006; | WHI (2003, 2006) | WHI (2002, 2004, 2006) | Events from study (see above) | WHI (2002, 2004) |
Gallbladder disease | Not included | Not included | Not included | Not included | Not included |
Ovarian Cancer | Not included | Not included | Not included | Not specified but events from the study possibly included | Not included |
Pulmonary Embolism (PE) | WHI (2002, 2004); two meta-analyses, 2002; data from a decision model of short term MHT on symptom relief, 2004; | Included under VTD | Included under VTD | Events from study (see above) | Included under VTD |
Stroke | Stroke was considered together with CHD as one disease category | WHI (2007) | WHI (2002, 2004) | Events from study (see above) | WHI (2002, 2004) |
Urinary incontinence | Not included | Not included | Not included | Not included | Not included |
Venous thrombo-embolic disease (VTD) | PE events included but not DVT | WHI (2004, 2006) | WHI (2002, 2004) | Covered by DVT and PE | WHI (2002, 2004) |