OBJECTIVES: In China there is a lack of awareness of HRT as a treatment option to alleviate climacteric symptoms apart from herbal or traditional Chinese medicines (CM). This study aims to assess economic impact of reimbursing 17-ß-estradiol combined HRT from Chinese payer’s perspective. METHODS: An economic analysis based on Danish Osteoporosis Prevention Study (DOPS) efficacy data was conducted to model an assumptive cohort of 100,000 women in 2 comparisons, namely HRT based on 2mg 17-ß-estradiol and 10 mg Dydrogesterone versus mixed-treatment cohort, (including 41% no treatment after clinical consultations and 59% treated using CM), and a second comparison of HRT versus 100% CM (50,000 for each group). Long-term fracture, cardiovascular (CV) events and drug procurement costs are evaluated as main outcomes. Cost data are obtained from Shanghai Patient Electronic Medical Records. Daily drug cost is ¥4.39 for HRT based on the only available 17-ß-estradiol included combination drug in China and ¥12 for alternative treatment based on the market research. 5-year continuous treatments with 65% compliance and 10% patients’ copayment are reported as base-case scenario. RESULTS: The per person costs to achieve fracture free 5 year for HRT, CM-59%, and CM-100% cohorts was ¥831, ¥1,370, and ¥2,276, respectively. The cost per CV event free 5 year for HRT, CM-59%, and CM-100% cohorts was ¥814, ¥1,363, and ¥2,275, respectively. The cost savings achieved with HRT compared to CM-59%, and CM-100% cohorts was ¥544 and ¥1453, respectively. Comparing the costs for 50,000 women using HRT with CM-59%, and CM-100%, a savings of ¥143 million and ¥369 million, respectively was achieved. CONCLUSIONS: Although the willingness for Chinese menopausal women to seek treatment is quite low, treating all those who have sought clinical consultations with HRT rather than maintaining use of CM may save healthcare expenditure.