Date and Time
April 23, 2003
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Objective: Breast cancer is the most common malignancy in women. Recent evidence suggests that selective estrogen receptor modulators (SERM's) may benefit in preventing breast cancer. However, it is well known that these SERM's also cause a variety of adverse events such as stroke, thromboembolic disease, hot-flashes and endometrial cancer. We examined the cost effectiveness of prescribing either tamoxifen or raloxifene to women for the primary chemoprevention of breast cancer. Design: In order to evaluate both the potential benefits and harms of SERM therapy, we developed a decision and cost-effectiveness analyses utilizing a semi-Markov life model that incorporates multiple individual disease states. Risk ratios for SERM use with regards to breast cancer, endometrial cancer, stroke and thromboembolic disease were obtained via a meta-analysis of published randomized control trials. The baseline probabilities of breast cancer, other adverse or positive effects, death and quality-of-life estimates were obtained from the literature. Costs were estimated from a literature review. Patient Population: Two cohorts of Caucasian women age 50 with or without an intact uterus at average risk, given age for breast cancer were analyzed. The long-term SERM protective effects after discontinuation of chemoprevention was evaluated from 0 to 15 years. Main Outcomes: Quality-adjusted survival and marginal cost-effectiveness of tamoxifen and raloxifene as compared to no therapy was analyzed.