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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 . . . [Full Text of this Article]

AUTHOR INFORMATION
Nananda F. Col, MD, MPP, MPH; Anne Stiggelbout, PhD; Phaedra Corso, PhD

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