Breast Cancer Prevention With Tamoxifen Appears Cost-Effective

ATLANTA—Compared with other accepted medical interventions, breast cancer prevention with tamoxifen (Nolvadex) therapy is cost-effective, according to a poster presented at the ASCO annual meeting

The risk of developing invasive and noninvasive breast cancers was reduced by 49% and 50%, respectively, among women taking tamoxifen in the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 Breast Cancer Prevention Trial (BCPT).

 “That risk reduction,” said Les L. Noe, MPA, Ovation Research Group, Highland Park, Illinois, “translates to a cost per life-year gained within a range similar to other commonly accepted therapies such as screening mammography, HIV treatment, and the use of the ACE inhibitor captopril (Capoten) for treating hypertension.”

In this decision-analysis model, lifetime discounted incremental costs and effects were calculated using data on the benefits and risks of tamoxifen as observed in the BCPT and using treatment costs from the literature.

Researchers estimated the incremental cost-effectiveness of using tamoxifen as preventive therapy in age-group-defined cohorts of women at high risk for developing breast cancer, compared with no prevention. They also evaluated the cost-effectiveness of tamoxifen in the subgroup of women with a previous hysterectomy.

Beyond drug costs, investigators included such factors as savings from disease avoided and costs from higher rates of endometrial cancer.

“Under the most conservative assumptions from our base-case analysis,” Mr. Noe said, “the incremental cost-effectiveness of tamoxifen is $41,372 per life-year gained for women aged 35 to 49 years, and $68,349 and $74,981, respectively, for women aged 50 to 59 years and 60 to 69 years.” In women with a previous hysterectomy receiving tamoxifen, regardless of age, cost-effectiveness is $46,060 per life-year gained.

Cost-effectiveness improves to as low as $10,196 per life-year gained under “more reasonable scenarios” where tamoxifen’s effects persist beyond 5 years and health benefits are not discounted, Mr. Noe reported.

In comparison, the cost per life-year gained for zidovidine (AZT, Retrovir) treatment for HIV disease is about $85,000; for captopril for hypertension, $80,000; and for screening mammography in women under age 50, $230,000.

Cholesterol-lowering with lovastatin (Mevacor) costs between about $105,000 to $210,000 per life-year saved, depending on the dose taken and the age of the recipient. Coronary artery bypass surgery costs just over $10,000 per life-year saved.

The Bottom Line

“The bottom line is that it is still a personal decision made between the physician and the patient. This analysis just shows that they should not be deterred from choosing tamoxifen therapy based on economic impact,” Mr. Noe said.

He concluded that a tamoxifen prevention strategy to reduce the incidence of breast cancer is particularly cost-effective in women aged 35 to 49 years and in women of all ages with a previous hysterectomy.