Cost-effectiveness of radioguided occult lesion localization (ROLL) versus wire-guided localization (WGL) in breast conserving surgery for nonpalpable breast cancer: results from a randomized controlled multicenter trial

E L Postma, H Koffijberg, H M Verkooijen, A J Witkamp, M A A J van den Bosch, R van Hillegersberg

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Accurate preoperative localization of nonpalpable breast cancer is essential to achieve complete resection. Radioguided occult lesion localization (ROLL) has been introduced as an alternative for wire-guided localization (WGL). Although efficacy of ROLL has been established in a randomized controlled trial, cost-effectiveness of ROLL compared with WGL is not yet known. The objective of this study was to determine whether ROLL has acceptable cost-effectiveness compared with WGL.

METHODS: An economic evaluation was performed along with a randomized controlled trial (ClinicalTrials.gov, No. NCT00539474). Women (>18 years) with histologically proven nonpalpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomized to ROLL (n = 162) or WGL (n = 152). Empirical data on direct medical costs were collected, and changes in quality of life were measured over a 6-month period. Bootstrapping was used to assess uncertainty in cost-effectiveness estimates, and sensitivity of the results to the missing data approach was investigated.

RESULTS: In total, 314 patients with 316 invasive breast cancers were enrolled. On average ROLL required the same time as WGL for the surgical procedure (119 vs 118 min), resulted in a 7 % higher reinterventions risk, and 13 % more complications. Quality of life effects were similar (difference 0.00 QALYs 95 % CI (-0.04-0.05). Total costs were also similar for ROLL and WGL (+<euro>26 per patient 95 % CI <euro>-250-311).

CONCLUSION: ROLL is comparable to WGL with respect to both costs and quality of life effects as measured with the EQ5D and will therefore not lead to more cost-effective medical care.

Original languageEnglish
Pages (from-to)2219-2226
Number of pages8
JournalAnnals of Surgical Oncology
Volume20
Issue number7
DOIs
Publication statusPublished - Jul 2013

Keywords

  • Aged
  • Breast Neoplasms
  • Carcinoma
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Humans
  • Mastectomy, Segmental
  • Middle Aged
  • Neoplasm, Residual
  • Operative Time
  • Quality-Adjusted Life Years
  • Reoperation
  • Sentinel Lymph Node Biopsy
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial

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