ATLANTACompared 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
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
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 tamoxifens
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