Lessons From WHI, Part 3: Cost-Effectiveness

Henry R. Black, MD; Rebecca D. Jackson, MD


July 08, 2014

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Editor's Note: This is part 3 of Dr. Black's interview with Dr. Rebecca Jackson on the Women's Health Initiative (WHI) studies.

Part 1, on the hormone therapy findings, is available here.

Part 2, on the calcium and vitamin D supplementation and dietary modification trials, is available here.

And part 4, in which Dr. Jackson reminisces on paying it forward and the rewards of working on an important clinical trial, is available here.

Henry R. Black, MD: Hi. I'm Dr. Henry Black, Adjunct Professor of Medicine at the New York University Langone School of Medicine. I am here today with my colleague, Dr. Rebecca Jackson, from the Ohio State University.

I was the principal investigator at one of the 40 sites for the WHI when I was at Rush University in Chicago, and Dr. Jackson has been there ever since -- about 20 years now. I want to ask you about a study that was recently published in the Annals of Internal Medicine,[1] which is an economic look at whether this $600 million investment was worth it. It was pretty impressive. Have you had a chance to check that out?

Rebecca D. Jackson, MD: Yes. It has been fascinating. Over the years, we looked at WHI as this incredible resource for the country and certainly for women's health. One way of looking at the impact -- besides the 1000-2000 scientific articles in all areas, including new diagnostic strategies and new interventions for maintaining changes -- was to ask how these results increase knowledge and change the way we practice medicine. In this study, they tried to look at the economic value of the WHI. As a result of the WHI trials, we found that by the changes in prescribing patterns for hormone therapy that resulted from the WHI findings, there was evidence for 126,000 fewer cases of breast cancer. In terms of managing menopausal symptoms in women who can't manage them through lifestyle alone, there has been a reduction of almost 76,000 cardiovascular events.

Unfortunately, there was also an increase of more than 250,000 fractures because hormone therapy is a very effective approach for reducing risk for fractures. Overall, there was a significant gain of about 140,000 quality-adjusted life-years as a result of the WHI. For every dollar spent in conducting the WHI, there was a benefit of more than $140, or about $35 billion overall benefit as a result of this study. It is a real benefit to science when we can make better healthcare recommendations and they are adopted. WHI did a very good job of disseminating the information in ways that physicians and other healthcare providers and the people who are most important -- the women themselves -- could use it to make healthcare decisions.

Dr. Black: Rebecca, thank you very much for this overview. This study[2] is going to continue to give for a long time. Women between ages 50 and 79 years who are postmenopausal have contributed a great deal by participating, and those of us who were part of it are very proud to have helped get it done. Thank you very much.


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