Cost‐effectiveness of chemoprevention of breast cancer using tamoxifen in a postmenopausal US population

Abstract

BACKGROUND: Previous cost-effectiveness analyses of tamoxifen therapy account for breast cancer risk reduction during active treatment but not for its persistent protective effect after active treatment. METHODS: A detailed, continuous time, mathematical model of breast cancer and healthcare processes was used to simulate a postmenopausal population aged <55 years in a virtual trial comparing tamoxifen treatment with no treatment for lifetime follow-up. Unlike previous work, the current model of tamoxifen therapy is based on a meta-analysis of 4 randomized, placebocontrolled chemoprevention trials with breast cancer risk reduction continuing for 10 years after treatment termination. Cancer incidence and survival data were derived from Surveillance, Epidemiology and End Results statistics. Noncancer disease incidences, quality-adjusted life year (QALY) utility weights, and costs were derived from the literature. RESULTS: Tamoxifen treatment (vs no treatment) saved 29 QALYs in a population of 1000 postmenopausal women aged <55 years with an additional cost of $333,000 over the population's lifetime (average cost-effectiveness ratio, $11,530 per QALY). Tamoxifen therapy, compared with no treatment, was cost saving when higher risk populations were targeted (5-year risk !1.66%). The cost-effectiveness results were sensitive to parameters that characterized menopausal symptoms and adverse side effects of tamoxifen. CONCLUSIONS: The current results indicated that tamoxifen chemoprophylaxis for postmenopausal women aged <55 years is a cost-effective health policy that reduces breast cancer incidence and improves life expectancy. Focusing on a postmenopausal population aged <55 years minimized the threat of adverse events associated with tamoxifen. Cancer 2011;117:3322-

The National Cancer Institute’s PREVENT Cancer Preclinical Drug Development Program: overview, current projects, animal models, agent development strategies, and molecular targets

“…A recent study demonstrates just how cost effective preventing cancer with drugs can be [7]. In this analysis, the benefits of using the selective estrogen receptor (ER) modulator (SERM) tamoxifen to prevent breast cancer were modeled in postmenopausal women less than age 55 at the start of treatment.…”

“…Compared to no treatment, tamoxifen use was highly cost-saving when higher risk populations were targeted (five-year risk ≥1.66%). Tamoxifen use in this population was forecast to save 85 quality-adjusted life years per 1000 postmenopausal women and provide cost savings of $47,580 compared with no treatment over a lifetime of follow-up [7]. However, the acceptance of tamoxifen to prevent breast cancer is poor because of the fear of endometrial cancer, thromboembolism, and other side effects; therefore, better agents are still needed in this niche (reviewed in [9]).…”

1064 a Novel Simulation Model of Non-Muscle Invasive Bladder Cancer a Platform for a Virtual Randomized Trial of Conservative Therapy vs Cystectomy in BCG Refractory Patients

“…compliance with treatments, maintaining physician appointments etc) into medical models [8]. The Archimedes model has previously been utilized to study cost effectiveness of breast cancer and colorectal cancer screening [9,10]. Using the Archimedes model we simulated an RCT comparing radical cystectomy versus intravesical MMC therapy to evaluate the clinical and economic outcomes for BCGrefractory patients with NMIBC and to demonstrate the utility of computer based models to simulate a clinical trial.…”

Cost-effectiveness of a Genetic Test for Breast Cancer Risk

“…This model includes diabetes, congestive heart failure, coronary artery disease, stroke, hypertension, obesity, and cancers of the breast, lung, colon, and bladder. For purposes of this study, we focus on the breast cancer model, which includes the growth, detection and spread of tumors as well as screening and treatment (17). Each patient receives a random age of breast cancer diagnosis by symptoms, calculated by integrating over the hazard function specific to her risk.…”

“…The Archimedes model is a large-scale, individually based, continuous-time discrete-event simulation (15)(16)(17). This model includes diabetes, congestive heart failure, coronary artery disease, stroke, hypertension, obesity, and cancers of the breast, lung, colon, and bladder.…”