Cost-Minimization Analysis of Vacuum-Assisted Biopsy Versus Surgical Biopsy for the Diagnosis of Suspicious Breast Lesions in the Brazilian Public Health System

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2026-05-01 Epub Date: 2026-03-24 DOI:10.1016/j.clbc.2026.03.013

Andressa Gonçalves Amorim , André Mattar , Marcelo Antonini , Claudia Ribeiro Martins Cabrera , Marina Diógenes Teixeira , Francisco Pimentel Cavalcante , Felipe Pereira Zerwes , Eduardo Camargo Millen , Fabricio Palermo Brenelli , Antônio Luiz Frasson , Marcelo Madeira , Gil Facina , Henrique Lima Couto , Marcellus do Nascimento Moreira Ramos , Patrícia Rodrigues Alves de Figueiredo Moraes , Marina Fleury de Figueiredo , Reginaldo Guedes Coelho Lopes , Luiz Henrique Gebrim

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引用次数: 0

Abstract

Background

Breast biopsy is important in the diagnostic pathway for suspicious mammographic findings. Although vacuum-assisted biopsy (VAB) offers recognized technical and clinical advantages over surgical biopsy (SB), including reduced invasiveness and faster recovery, its economic impact within public healthcare systems remains insufficiently characterized, especially in low- and middle-income countries.

Methods

We performed a cost-minimization analysis comparing VAB and SB within the Brazilian public healthcare system. A decision tree model with a 1-month time horizon was developed using real-world data from 1833 consecutive biopsy procedures conducted at a high-volume public cancer center. Clinical equivalence was assumed based on comparable diagnostic accuracy between techniques. Costs were assessed from institutional (hospital provider), public payer (Sistema Único de Saúde [SUS]), and societal. Deterministic sensitivity and break-even analyses were conducted to test model robustness.

Results

From the institutional perspective, VAB generated mean savings of USD 223 per patient compared with SB. From the societal perspective, savings reached USD 353 per patient, largely driven by shorter recovery times and lower productivity losses. Conversely, from the SUS payer perspective, VAB was associated with higher direct reimbursement costs, with an incremental cost of USD 146 per patient. Sensitivity and break-even analyses confirmed the stability of these findings across wide parameter variations.

Conclusion

Within a public healthcare setting, VAB represents a more economically efficient diagnostic strategy than SB from institutional and societal perspectives, despite higher upfront reimbursement costs. Aligning payment policies with high-value, minimally invasive approaches may improve efficiency and equitable access in breast cancer diagnosis.

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巴西公共卫生系统中诊断可疑乳腺病变的真空辅助活检与外科活检的成本最小化分析

背景：乳腺活检在可疑的乳房x线检查中具有重要的诊断意义。尽管真空辅助活检（VAB）比外科活检（SB）具有公认的技术和临床优势，包括减少侵入性和更快的恢复，但其在公共卫生系统中的经济影响仍未充分描述，特别是在低收入和中等收入国家。方法：我们对巴西公共卫生系统中VAB和SB进行了成本最小化分析。一个具有1个月时间范围的决策树模型是利用在一个大容量公共癌症中心进行的1833个连续活检程序的真实数据开发的。临床等效假定是基于技术之间可比较的诊断准确性。成本从机构（医院提供者）、公共支付方（Sistema Único de Saúde [SUS]）和社会进行评估。采用确定性敏感性和盈亏平衡分析来检验模型的稳健性。结果：从机构角度来看，与SB相比，VAB为每位患者平均节省了223美元。从社会角度来看，每位患者节省了353美元，这主要得益于更短的恢复时间和更低的生产力损失。相反，从SUS支付者的角度来看，VAB与更高的直接报销成本相关，每位患者的增量成本为146美元。敏感性和盈亏平衡分析证实了这些发现在广泛参数变化中的稳定性。结论：在公共医疗环境中，从制度和社会的角度来看，VAB代表了比SB更经济有效的诊断策略，尽管前期报销成本更高。调整支付政策与高价值，微创方法可以提高乳腺癌诊断的效率和公平获取。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.