Tamoxifen Prophylaxis Is Cost-Effective, Should Be Covered by Insurance

According to the first cost-effectiveness analysis of tamoxifen (Nolvadex), high-risk women who use tamoxifen to prevent breast cancer should be reimbursed by medical insurance in the same way as other preventive drugs and procedures are reimbursed. Currently, some patients who are not enrolled in clinical trials must pay the annual $1,000+ expense themselves.

The analysis found that tamoxifen “is one of the most cost-effective medical interventions known,” according to Thomas Smith, MD, of Massey Cancer Center at Virginia Commonwealth University, lead author of the study. “Compared to most forms of medical treatment, it makes sense for insurers and society to fund.”

Both Smith and Bruce Hillner, MD, also of the Massey Cancer Center, estimate that tamoxifen will prevent 1,665 cancers for every 100 women who take the drug for 5 years, as was reported by the National Surgical Adjuvant Breast and Bowel Project. If a death from breast cancer is fully prevented by this drug, then the cost-effectiveness of tamoxifen compared to no intervention is $8,479 per additional year of life gained. In other words, to save one year of life for an individual woman would cost society $8,479. According to Smith, the cost of the drug, as well as the costs of both side effects and additional procedures, must all be balanced against the effectiveness of tamoxifen.

Costs Are Well Below the Standard Benchmark

At $8,479 per additional year of life gained, the sum is well below the $50,000 that is now a standard benchmark for whether or not a drug is cost effective. Smith says that “using tamoxifen is more cost-effective than the use of either mammography for detecting early breast cancer or hypertension drugs for preventing strokes and heart attacks—each of which cost about $20,000 per year of life gained. And those drugs are clearly seen as a societal good.”