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
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
attackseach of which cost about $20,000 per year of life
gained. And those drugs are clearly seen as a societal good.