In 2002, WHI Investigators released findings from the WHI Estrogen Plus Progestin (E+P) Trial showing that the risks from using E+P hormone therapy outweighed the benefits. These findings led to a huge reduction in the use of this type of hormone therapy among postmenopausal women. Until now, the economic effect of this change has not been studied.
On May 6th, WHI investigators, led by Joshua Roth, PhD, published a paper in the Annals of Internal Medicine that looked at the economic impact the E+P findings have had in the United States between 2002 and 2012. To do this, they created a mathematical model that looked at health outcomes and economic costs related to two possible scenarios 1) the “WHI scenario”, which looked at what has happened since the release of the results, and 2) the “no-WHI scenario”, which projected what might have happened if the WHI had not occurred. The model estimated disease rates, disease costs, and health-related quality of life for each of the two scenarios. In terms of hormone therapy use, the model estimated that 5.2 million women used hormones in the WHI scenario, and 9.5 million women would have used hormones in the no-WHI scenario (i.e., an additional 4.3 million women would have used E+P hormones if the WHI results had not occurred).
When taking the estimated health costs and outcomes from the two scenarios into account, the model showed that the WHI scenario, when compared with the no-WHI scenario, resulted in a $35.2 billion savings in direct medical costs (measured in 2012 dollars). These savings were mainly due to fewer women buying hormone pills and the decrease in rates of breast cancer and cardiovascular disease resulting from the reduction in hormone use. In the no-WHI scenario, it was estimated that there would have been fewer bone fractures and fewer cases of colorectal cancer than in the WHI scenario, but the cost savings from the reduced cases of breast cancer and cardiovascular disease in the WHI scenario were much greater. The investigators also calculated health-related quality of life for each scenario and found that the increase in quality adjusted life years associated with decreased rates of breast cancer and cardiovascular disease was greater than the decrease in quality adjusted years of life due to fractures.
The cost of conducting the WHI E+P trial, which was funded by the National Heart, Lung, and Blood Institute at the National Institutes of Health, was $260 million (again in 2012 dollars). The goal of this paper was to look at the “return” on that investment, i.e., what did we get for all that time and money? When all costs and quality-adjusted years of life are considered, the total economic return of the WHI trial is an estimated $37.1 billion!
These findings suggest that investment in high quality trials of important topics may have a high rate of return in terms of public health and medical costs life. This represents a return on all of the WHI participants' investments of their time, effort and dedications. We want to again sincerely thank the thousands of women who made the WHI trials possible.
Click here to access the full article.
Update: Since the publication of this article, several news and science websites have reported on these results. Here are links to the story on a few of those sites:
U.S. News & World Report – Major Women's Health Study Paid Big Dividends
MedPage Today – WHI: Millions Spent, but Billions Gained
CenterWatch – Study: $260M on WHI Trial has saved $37B in healthcare costs
Science Codex - WHI reports $37.1B economic return on combined hormone therapy trial
Science Daily – Combined hormone therapy trial yields massive economic return