2002 年 11 巻 p. 23-42
In this aging society, female hormone replacement therapy (HRT) has begun to attract close attention, not only for its efficacy in disease prevention and improvement of the quality of life of middle-aged and elderly women, but also from the aspect of health economics. In Western countries, HRT is administered to 20-30% of all postmenopausal women, and there has been discussion about its cost-effectiveness in helping to prevent fractures, angiopathy, etc. In Japan, this therapy is used less extensively (only about 1/10 as frequently) than in Western countries, and there has been little discussion on this therapy from a health economics standpoint in Japan. The present study aimed to evaluate HRT in Japan from the economic viewpoint, by calculating the cost of HRT itself and the economic impact through its effect of preventing bone fractures.
The present study focused on the relationship of HRT to osteoporosis and fractures, because its effectiveness in preventing other pathologic conditions has not yet been established. The medication cost of HRT was estimated at about 140 billion yen per year, if it were administered to all postmenopausal women with osteoporosis. The estimated cost of HRT was relatively small in comparison to that of other drug therapies for osteoporosis, even when side effects were taken into account.
When given to prevent osteoporosis and fractures, HRT was estimated, putting aside the cost of HRT itself, to reduce the direct cost of bone fracture care by 295.1 billion yen and the indirect cost by about 8.2 billion yen. Thus, a total reduction of about 303.3 billion yen by the administration of HRT was expected, suggesting that HRT could eliminate about 20% of the medical cost generally required for the treatment of osteoporosis and bone fractures. This analysis estimated the cost of the therapy itself and also the cost reduction due to the beneficial health effect of preventing osteoporosis, and suggested that HRT for postmenopausal women is comparable to or superior to other drug therapies conventionally used for osteoporosls. Considering also the clinical benefits of HRT of controlling conditions other than osteoporosis and fractures, HRT seems to be a promising therapy. It is desirable to analyze the factors hampering the acceptance of this therapy in Japan. In the future, clinical-epidemiological data should be collected and further economic analysis should be pursued, concerning this promising therapy and its related health conditions.
