Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer

Abstract

Background The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery. Methods This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62). Results The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted. Conclusion Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.

Cost-Effectiveness of Radar Localisation Versus Wire Localisation for Wide Local Excision of Non-palpable Breast Cancer

“…This is the first published study to date that assessed both surgical outcomes and costs between RL and WL in WLE for early-stage breast cancer. 25 The results support previous findings that there was no significant difference in surgical outcomes between RL and WL techniques. 2 , 3 , 8 – 11 It also demonstrated that WLE using RL was a cost-effective technique for reducing delays in surgery related to preoperative localisation with WL.…”

“…The costs involved with a new technology compared to current “gold standard” is a crucial consideration in its adoption. 25 Compared with most wireless techniques, WL is economical. 29 – 31 RL requires additional expenditure, including consideration of upfront costs of the console and guidance probe.…”

Preoperative non-palpable breast lesion localization, innovative techniques and clinical outcomes in surgical practice: A systematic review and meta-analysis

“…NWNI techniques need an early capital expenditure for the intraoperative detection equipment to be used and most of the cost savings are indirect: the most noticeable, if compared with RSL, is the unnecessary involvement of nuclear medicine personnel and resources. All the cited techniques have direct and indirect costs that shall be carefully evaluated for their cost assessment, as done in several papers [ [79] , [80] , [81] , [82] , [83] , [84] ]. It is noteworthy that all cost-savings (both direct and indirect) can vary from institution to institution depending on several logistic factors, such as the location of the theatre and admission wards, the radiologists’ workloads, the structure of the clinics, and the cancer workload.…”

Cosmetic outcomes following wide local excision of impalpable breast cancer: is radioguided occult lesion localization using iodine‐125 seeds better than hookwire localization?

“…ROLLIS has a number of advantages over HWL, including lack of movement after insertion, 21 improved patient satisfaction, 22 higher ease of use by radiologists and surgeons, 23 more efficient use of radiology and theatre booking 24 and higher cost effectiveness 25 . Although we have not been able to show a significant difference in overall cosmetic outcomes for women having BCS guided by ROLLIS compared with HWL, the lack of demonstrable detrimental effect adds further evidence to support increased uptake of ROLLIS for pre‐operative localization prior to BCS.…”