Cost analysis of managing B3 breast lesions by vacuum excision at Leeds Breast Unit using a decision model

Abstract

ObjectiveTo develop an economic model to evaluate the cost of using vacuum-assisted excision (VAE) for managing B3 breast lesions.DesignA decision tree of managing B3 breast lesions was developed to compare the costs of VAE with diagnostic excision (DE) from the perspective of the healthcare provider. Two different diagnostic pathways were compared which describe alternative approaches to the management of B3 lesions using inputs derived from a mix of primary and secondary data.SettingBased on a study conducted at Leeds Breast Unit, UK.Participants398 patients enter the model having undergone initial core needle biopsy, or vacuum-assisted biopsy, and diagnosed with B3 breast lesion.Main outcome measuresThe economic impact, in terms of cost, of various scenarios using analysis of extremes and probabilistic sensitivity analysis.ResultsVAE reduced the cost per patient by £1510.75. Analysis of extremes showed that managing B3 lesions using VAE was cost saving except the case where a combination of the highest cost associated with VAE and the lowest cost for DE were used. Probabilistic sensitivity analysis showed that using VAE for managing B3 lesions has a probability of 0.9 of being cost saving compared with using DE.ConclusionThis analysis shows the potential cost saving of using VAE as an alternative for managing B3 breast lesions compared with DE. Further research in this area and the effect of the VAE on patients’ quality of life is warranted.