Semester

Spring

Date of Graduation

2003

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Sciences

Committee Chair

Suresh Madhavan.

Abstract

The primary objective of the study was to estimate the long-term benefits and costs of chemopreventive tamoxifen and mammography screening in women who are otherwise healthy but at high risk of developing breast cancer. Three hypothetical cohorts of high-risk women were initiated at age forty. The first cohort consumed chemopreventive tamoxifen and underwent routine mammography screening. The second cohort also consumed chemopreventive tamoxifen but underwent mammography screening at real-world rates. The third cohort (control cohort) did not consume chemopreventive tamoxifen and underwent mammography screening at real-world rates. The study also assessed the proportion of women in the West Virginia Medicaid Program (WVMP) who were healthy but at a high risk of developing breast cancer. Secondary objectives of the study involved determining breast cancer knowledge, utilization of breast cancer preventive strategies, and willingness to consume chemopreventive tamoxifen. Chemopreventive tamoxifen coupled with routine mammography screening resulted in an incremental life expectancy gain of 0.122 years at an incremental cost of {dollar}5,969.70 resulting in an incremental cost effectiveness ratio (ICER) of {dollar}48,931.80 per life year gained (3% discount rate) as compared to control cohort. Chemopreventive tamoxifen coupled with mammography screening at real-world rates resulted in an incremental life expectancy gain of 0.076 years at an incremental cost of {dollar}4,916.84 resulting in an incremental cost effectiveness ratio (ICER) of {dollar}64,695.20 per life year gained (3% discount rate) as compared to control cohort. Sensitivity analysis indicated robustness of results over a wide rage of assumptions. About half of the surveyed population was at a high risk of developing breast cancer and thus eligible to receive chemopreventive tamoxifen. However, only about 17% respondents indicated their inclination towards consuming chemopreventive tamoxifen. A low but significant correlation was observed between the respondent's perceived risk and real risk indicating the need for increasing breast cancer awareness. Respondent's actual risk of developing breast cancer did not appear to have any relationship with willingness to consume chemopreventive tamoxifen. In summary, chemopreventive tamoxifen plus mammography screening in high-risk women is a cost-effective strategy. However, at present, very few of these high-risk women may actually utilize chemoprevention.

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