Tamoxifen chemoprevention cost-effective for middle-aged women

Findings from a new study suggest that using tamoxifen to prevent breast cancer is cost-effective for women between 40 and 50 years of age, provided that their 5-year risk of breast cancer is at least 3.4%. For older women, the risk needs to be higher for this approach to remain cost effective.

The findings are based on an analysis that compared the outcome of a hypothetical 50-year-old patient who received tamoxifen for 5 years with a patient who did not. Data from the Breast Cancer Chemoprevention Trial and other published sources were used to generate probabilities and costs of outcomes. Quality of life estimates were derived from 106 women. In the hypothetical patient, tamoxifen prophylaxis was associated with 26.07 quality-adjusted life-years (QALYs), whereas no treatment provided 25.97 years. For each QALY gained, the cost was $43,300.As noted, tamoxifen was deemed cost-effective for women in their 40s who have a significant risk of developing breast cancer, lead author Dr. Samuel Cykert, from the University of North Carolina at Chapel Hill and colleagues report in the September issue of Obstetrics and Gynecology.For women between 60 and 65 years, tamoxifen prophylaxis was only cost-effective if the 5-year breast cancer risk exceeded 5%. For women over the age of 50, prophylaxis was considered cost-effective if the utility score for curable breast cancer fell below 0.7.The authors note that they would consider tamoxifen chemoprevention to be contraindicated in patients with a high risk of cerebrovascular disease or a hypercoagulable state.”Until new data are available, tamoxifen remains the only choice for the primary prevention of breast cancer and should be restricted to women who are systematically identified,” the authors conclude. (Source: Obstet Gynecol 2004;104:433-442: Reuters Health News: Oncolink: Spetember 2004.)