20 May, 2013:

Kleinman and colleagues have attempted to quantify the economic burden of employees who are diagnosed with menopause symptoms [1]. Their regression-based study analyzed the 2001–2010 medical, pharmacy, sick leave, disability, workers' compensation, and productivity data of large US employers. A cohort of employed women with diagnosed menopause symptoms (DMS), aged more than 40 years, was identified using medical claims. Control employees were propensity-matched on age, employer, plan enrollment length, and enrollment end date. The study included 17,322 women in each cohort. Employees with DMS had significantly higher medical costs ($4315 vs. $2972, p< 0.001), pharmacy costs ($1366 vs. $908, p < 0.001), sick leave costs ($647 vs. $599, p < 0.001), and sick leave days (3.57 vs. 3.30, p < 0.001). Employees with DMS had 12.2% (p = 0.007) lower hourly productivity and 10.9% (p = 0.014) lower annual productivity than controls.

Comment

For many years, the debate over the need for postmenopausal hormone therapy (HT) has focused on its potential protective effects (bone, cardiovascular system, cognition), even in asymptomatic women. The WHI trial data were destructive to this concept, since they brought to attention the therapeutic risk–benefit balance, which seemed at first to be so unfavorable. Somehow, the debate gave much less value to quality-of-life issues and ignored the fact that most women who use hormones actually seek relief from bothersome menopause-related symptoms, which can be treated effectively by HT [2]. Health-care and reimbursement programs must take into consideration various economic parameters, and thus payment just for better quality of life is usually not a priority. Several years ago, Salpeter and colleagues presented a pharmaco-economic model for the use of hormones, which was based on data from previous large studies, including the WHI [3]. They concluded that women who take HT for 15 years, starting at age 50 years, and then followed for their lifetime, may expect a gain of 1.49 quality-adjusted life years (QALYs), with a cost of 2438 USD/QALY when compared to non-users. This well-accepted way of measuring the cost-effectiveness of any treatment could serve as a platform for policy-makers and insurers to justify the promotion of HT use, since a value of 2500 USD per QALY is regarded in the US as a very cheap and therefore very worthy price for a medical intervention. As an example, studies on statin therapy in the UK evaluated the costs for one QALY, in the setting of primary prevention of coronary artery disease, to be £8000–30,000 [4].

The study by Kleinman and colleagues brings new perspectives, since it also examines aspects related to work productivity [1]. Employees with menopausal symptoms underperformed, with two fewer units of work per hour, compared with women without symptoms. Symptomatic women tended to be more depressed, had more emotional problems, and consumed more SSRIs and tranquilizers. They had a mean of 3.57 sick leaves per year, compared to 3.3 in the non-symptomatic women (p < 0.001). In another survey, the annual incremental total health-care expenditure on menopausal women with symptoms in the US was estimated to be within the range of 500–800 USD [5]. However, the current study puts additional parameters into the equation and therefore shows wider differences, with 40% higher costs related to being a symptomatic woman. This figure certainly has an impact on any nation's economy, and the remaining, intriguing question is whether or not HT and the consequent improvement of quality of life will lead to a reduction in this economic burden.
Amos Pines
Department of Medicine 'T', Ichilov Hospital, Tel-Aviv, Israel

References

1. Kleinman NL, Rohrbacker NJ, Bushmakin AG, et al. Direct and indirect costs of women diagnosed with menopause symptoms. J Occup Environ Med 2013 Mar 25. Epub ahead of print
http://www.ncbi.nlm.nih.gov/pubmed/23532198

2. Pines A, Sturdee DW, MacLennan AH. Quality of life and the role of menopausal hormone therapy. Climacteric 2012;15:213-16.
http://www.ncbi.nlm.nih.gov/pubmed/22612606 

3. Salpeter SR, Buckley NS, Liu H, Salpeter EE. The cost-effectiveness of hormone therapy in younger and older postmenopausal women. Am J Med 2009;122:42-52.
http://www.ncbi.nlm.nih.gov/pubmed/19114171  

4. Ward S, Lloyd Jones M, Pandor A, et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 2007;11:1-160.
http://www.ncbi.nlm.nih.gov/pubmed/17408535 

5. Kjerulff KH, Frick KD, Rhoades JA, Hollenbeak CS. The cost of being a woman: a national study of health care utilization and expenditures for female-specific conditions. Womens Health Issues 2007;17:13-21.
http://www.ncbi.nlm.nih.gov/pubmed/17321943 

Content updated 20 May 2013