Postmenopausal hormone therapy increases use of health services: Experience from the Estonian Postmenopausal Hormone Therapy Trial [ISRCTN35338757] Piret Veerus, MD, a,b,c, * Krista Fischer, PhD, d Sirpa-Liisa Hovi, Lic NSc, c,e Matti Hakama, PhD, c Mati Rahu, PhD, a,b Elina Hemminki, MD, Dr PH e Department of Epidemiology and Biostatistics, National Institute for Health Development (TAI), Tallinn, Estonia a ; Estonian Center of Excellence in Behavioral and Health Sciences, Tallinn-Tartu, Estonia b ; Tampere School of Public Health, Tampere, Finland c ; Department of Public Health, University of Tartu, Tartu, Estonia d ; Department of Health and Social Services, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland e Received for publication August 11, 2005; revised November 17, 2005; accepted December 19, 2005 KEY WORDS Postmenopausal hormone therapy Utilization of health services Health care costs Objective: This study was undertaken to compare utilization of health services and health care costs in a randomized hormone therapy trial. Study design: A total of 1823 healthy postmenopausal women aged 50 to 64 years at the time of sampling were allocated to combined continuous hormone therapy or placebo or no treatment. The analysis was based on routinely collected electronic data in the Estonian Health Insurance Fund database during a follow-up period from 2 to 5 years. Results: In the nonblind subtrial, the number of all health care visits was 10% higher and the number of visits to family practitioners 16% higher per person-year in the hormone therapy arm. Per person-year, the number of vaginal sonograms was 14% and the number of electrocar- diograms 19% higher in the nonblind hormone therapy arm. Outpatient health care costs and drug expenses were higher in the nonblind hormone therapy arm. In the blind subtrial, the num- ber of gynecologic operations, vaginal sonograms and total health care costs was higher in the hormone therapy arm. Conclusion: Hormone therapy caused additional expenses on health care. Ó 2006 Mosby, Inc. All rights reserved. Supported by the Academy of Finland (grants 69838 and 201490), STAKES (National Research and Development Centre for Welfare and Health), Finland, and the Estonian Ministry of Education and Research (target funding 0192112s02). Drugs were donated by Wyeth Ayerst Com- pany via the Women’s International Study of Long Duration Oestrogen After Menopause (WISDOM) in the United Kingdom. The funding bodies had no role in the study design, data collection, data analysis, data interpretation, writing of the report or in the decision to submit the paper for publication. * Reprint requests: Piret Veerus, Department of Epidemiology and Biostatistics, National Institute for Health Development (TAI), Hiiu 42, 11619 Tallinn, Estonia. E-mail: piret.veerus@tai.ee 0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2005.12.037 American Journal of Obstetrics and Gynecology (2006) 195, 62–71 www.ajog.org