Tamoxifen for Breast Cancer Prevention Makes Financial Sense
Jan. 18, 2000 (Baltimore) -- It makes economic sense for women at a high risk for breast cancer to use tamoxifen to reduce their chances of developing the disease, and insurance companies should pick up the tab, according to researchers.
Tamoxifen has been used as a breast cancer treatment for more than 20 years, but it was approved for lowering the risk of breast cancer in 1998 after a National Cancer Institute study showed that it reduced the incidence by almost half in women aged 35-49. Women currently using the medication for breast cancer prevention pay about $1,000 out of pocket annually.
"Tamoxifen is one of the most cost-effective medical interventions known," says Thomas Smith, MD, co-author of the study. "Compared to most forms of medical treatment, it makes sense for insurers and society to fund," he tells WebMD. Smith is chairman of the division of hematology and oncology with the Massey Cancer Center at Virginia Commonwealth University in Richmond.
In a study that appears in the current issue of the Journal of Clinical Oncology, Smith compared the costs of treating women with tamoxifen, sold under the name Nolvadex, to those associated with other common medical interventions. "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," says Smith. "Using tamoxifen is more cost-effective than mammography is in detecting early breast cancer, or the use of [high blood pressure] drugs to prevent strokes and heart attacks, each of which cost about $20,000 per year of life gained." A strong family history of breast cancer puts a woman at a higher risk of breast cancer.
Roy Smith, MD, director of medical oversight for the National Surgical Adjuvant Breast and Bowel Project, reviewed the study for WebMD. He says, "Since tamoxifen is well tolerated and the cost of treating breast cancer is so high, it's almost a no-brainer whether the drug should be used in women at high risk."
Possible side effects of tamoxifen therapy include hot flashes, vaginal irritation or dryness, blood clots, and endometrial cancer, or cancer of the uterus. Says Roy Smith, "Most endometrial cancers that do occur are found at an early stage and are low grade at diagnosis, so the mortality risk is almost zero. Management of the other possible side effects may be associated with a higher cost for tamoxifen use."
Neither doctor is prepared to recommend tamoxifen therapy as standard treatment for all women at high risk for breast cancer, however. According to Roy Smith, "Our data would point to that, but we have not made that recommendation. That would be a tremendous number of women on tamoxifen." Says Thomas Smith, "I think this is an issue each woman should discuss with her doctor. She should be prepared to ask questions about her individual risk of breast cancer compared with her risk for blood clots or some of the other complications of tamoxifen therapy."