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Prophylactic benefits of tamoxifen for postmenopausal women appear cost-effective
Noah-Vanhoucke J. Cancer. 2011;doi:10.1002./cncr.25926.
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Tamoxifen chemoprophylaxis showed cost-effective efficacies for reducing breast cancer incidence rates in postmenopausal women aged 55 years or younger, according to a study.
Researchers modeled tamoxifen therapy based on an analysis of four randomized, placebo-controlled cancer prevention trials that assessed the drug’s effect on women’s breast cancer risk for 10 years after treatment. The mathematical model was a detailed, continuous-time representation of breast cancer incidence, tumor growth, detection and spread, survival and health care processes associated with breast cancer.
Besides the normal risk factors in the natural history model (age, age of menarche, age of first live birth, number of previous benign breast biopsies and family history of breast cancer), the model accounted for race and ethnicity, age of menopause, BMI and use of combined hormone replacement therapy. Researchers validated incidence rates and survival information against data from 1980 to 2004 taken from the SEER database; factors such as non-cancer disease incidences, quality of life and costs were taken from the medical literature.
Researchers found that tamoxifen treatment vs. no treatment was cost-effective when higher risk populations were targeted (5-year risk ≥1.66%). Using tamoxifen saved 29 quality-adjusted life years in 1,000 postmenopausal women aged 55 years or younger and saved $333,000 during that population’s lifetime (average cost-effectiveness ratio, $11,530 per quality-adjusted life year), taking into account menopausal symptoms and adverse events and side effects caused by the drug.
“Because of the severity of the possible side effects, few women are taking tamoxifen chemoprophylaxis, despite the large proportion of women who are eligible to receive treatment,” researchers wrote. “Our current analysis indicates that the benefits of tamoxifen chemoprevention can compensate sufficiently for its side-effect profile in a postmenopausal population aged <55 years with a risk ≥1.66%. Tamoxifen use in this population is forecast to save 85 [quality-adjusted life years] per 1,000 postmenopausal women aged <55 years with cost-savings of $47,580 compared with no treatment over lifetime follow-up.”
Disclosure: The researchers report no relevant financial disclosures.
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