NEW YORK, Jan 14 (Reuters Health) -- The drug tamoxifen is highly
effective at preventing breast cancer in women at high risk and should be
covered by insurance, results of a recent analysis conclude.
Currently, only women enrolled in clinical trials are reimbursed for the
drug, which can cost more than $1,000 a year for women who are not enrolled in
trials.
"If insurance companies are using cost-effectiveness to make decisions
about whether to cover drugs then they should cover this," lead author Dr.
Thomas J. Smith told Reuters Health.
The cost-effectiveness analysis is presented in the January issue of the
Journal of Clinical Oncology.
Smith and co-author Bruce E. Hillner, with Massey Cancer Center at
Virginia Commonwealth University in Richmond, assumed that tamoxifen will
prevent 1.665 cancers for every 100 women who take the drug for 5 years. This
estimate is based on data from the National Surgical Adjuvant Breast and Bowel
Project (NSABP), a research group funded by the National Cancer Institute that
led the landmark study on tamoxifen.
The authors of the current study estimate that if a breast cancer death is
prevented, its cost-effectiveness is $8,479 for each year of life gained,
compared to no intervention. This is the cost to save a year of life for an
individual woman.
The unofficial benchmark of whether a drug is cost effective is set at
$50,000 for each additional year of life gained. Smith noted that most drugs
cost about $20,000 for each year of life gained.
"Tamoxifen is clearly in that ballpark and could be even less if a generic
brand was made widely available at a lower cost," he said.
The investigators note that the preventative benefit of tamoxifen is more
than the estimated reduction of breast cancer death from annual screening
mammography of 7 deaths per 10,000 women between 40 and 50 years of age.
Insurance companies routinely cover screening mammography in this group of
women.
Tamoxifen was found to prevent breast cancer in women at high risk,
including women with a genetic susceptibility. Side effects include increased
risk of stroke and uterine cancer.
