Magnetic seed versus guidewire-based breast cancer localization with magnetic lymph node detection: cost-minimization analysis.

Abstract

Magnetic seeds have comparable performance to guidewires in breast lesion localization with the advantages of shorter operating time, facilitated logistics, and higher staff satisfaction. However, the high cost of the device remains a concern and warrants health economic evaluation. This is a predefined health economic analysis of a pragmatic RCT including 426 patients (median age of 65 (interquartile range (i.q.r.) 56-71) years, median BMI of 26.6 (i.q.r. 24.0-29.8) kg/m2, and a median tumour size of 11 (i.q.r. 8-15) mm) with non-palpable breast cancer, randomized to localization of the tumour with either a magnetic seed or a guidewire. Sentinel lymph node detection was performed using superparamagnetic iron oxide nanoparticles, enabling a totally magnetic approach. A cost-minimization analysis was conducted, from a healthcare system perspective, using unadjusted and adjusted analyses of costs. The unadjusted analysis did not show any difference in incremental costs (guidewire €3337 versus magnetic seed €3274; difference -€63 (95% c.i. -€302 to €174); P = 0.599). The adjusted analysis, including marker, type of breast surgery performed, and single-session lesion and SLN localization, showed that the magnetic seed was associated with reduced costs (guidewire €3514 versus magnetic seed €3123; difference -€391 (95% c.i. -€422 to -€360); P = 0.002), corresponding to a 11.1% reduction. Sensitivity analyses did not change direction of outcome. In this predefined health economic analysis of an RCT, the use of magnetic seeds resulted in incremental cost containment, despite the increased cost of the device. Contributing factors included shorter localization time, shorter operating time, and process streamlining.