Magnetic seed vs guidewire breast cancer localization with magnetic lymph node detection: a cost-minimization analysis

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Abstract Introduction Magnetic seeds have comparable performance to guidewires in breast lesion localization with the advantages of shorter operative time, facilitated logistics and higher staff satisfaction. However, the higher cost of the device remains an issue, meaning the health economy studies in this field are needed to inform on this question. Method This is a predefined health economic analysis of a pragmatic randomized controlled trial (RCT) including 426 patients (median [iqr] age 65 [56, 71] years; BMI 26.6 [24.0,29.8] kg/m2; tumour size 11 [8, 15] mm) with non-palpable breast cancer, randomized to either a magnetic seed or a guidewire, whereas 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. Result The unadjusted analysis did not show any difference in incremental costs (guidewire €3337 vs seed €3274; difference -63 [95% CI -302, 174], p-value=0.599). However, in the adjusted analysis including marker, type of breast surgery performed and single-session lesion and SLN localisation, showed that the seed was associated with reduced costs (guidewire €3514 vs seed €3123; difference -391 [95% CI -360, -422], p=0.002), corresponding to a 11.1% reduction. Sensitivity analyses did not change direction of outcome. Discussion 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 and operation time and process streamlining.

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