We agree with Dr Ohsfeldt’s comments about the importance of incorporating common, but less serious, adverse effects associated with HT in decision models. In fact, our decision model explicitly factored in the higher rate of abnormal mammograms associated with HT use (8.8% vs 5.9% among HT users vs nonusers1) and the loss in QOL associated with having either true-positive or false-positive mammogram results (QOL of 0.80 and 0.75, respectively).2 We implicitly accounted for the impact of uterine bleeding and vaginal discharge (the symptoms that typically lead to endometrial biopsy or transvaginal uterine ultrasound) in our analyses by downwardly adjusting the beneficial effect of HT on menopausal QOL by 6% (from 80%-90%3,4 to 80%) to account for the induction of adverse effects associated with HT. We chose not to explicitly account for the transient loss in QOL associated with undergoing endometrial biopsy and transvaginal uterine ultrasound. Because of the very brief duration of these procedures (minutes), their inclusion would not appreciably affect our results. The impact on QOL of any transient phenomena is infinitesimally small in analyses that examine the impact of treatment decisions over future lifespan. As such, decision models are typically insensitive to transient reductions in QOL, even if the magnitude of the loss during that brief interval were substantial. For example, under the most extreme scenario in which all HT users but no nonusers underwent endometrial biopsy and the procedure was assumed to last the entire day with a complete loss of QOL during that time, this amounted to a change of 1 quality-adjusted day in our analyses.
Col NF, Stiggelbout A, Corso P. Common Adverse Effects of Short-term Hormone Therapy—Reply. Arch Intern Med. 2005;165(5):588. doi:10.1001/archinte.165.5.588-a
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