Cryoablation Versus Breast-Conserving Surgery for Early-Stage, Low-Risk Breast Cancer ≤ 1.5 cm: A Cost-Effectiveness Analysis

Abstract

Purpose: To compare ultrasound-guided cryoablation (BCA) and breast-conserving surgery (BCS) for patients with early-stage, low-risk breast cancer using a cost-effectiveness analysis. Materials and Methods: A Markov decision tree was constructed comparing BCA and BCS for unifocal small (≤ 1.5 cm), lymph node-negative, ultrasound-visible breast cancer from a payer’s perspective over a 5-year horizon. Clinical outcomes after cryoablation were based on the ICE3 trial, and those after BCS were based on a meta-analysis of 17 trials. Outcomes were measured in US dollars and quality-adjusted life years (QALY). Base case calculation, probabilistic and deterministic sensitivity analyses were performed. Results: Base case analysis showed BCA achieved comparable health outcomes (0.01–0.09 QALY higher) at a lower cost (at least $17,682 of cost saving per patient). Probabilistic sensitivity analysis showed cryoablation to be the better strategy in majority of the iterations driven by its lower procedural cost. BCS became the better strategy when the annual mortality after BCA was > 2.1%, equivalent to a 5-year cancer survival after BCA < 90.0%. BCA was the more optimal strategy when its annual local recurrence risk was < 51.5% or distant recurrence risk was < 1.04%. BCS became the more cost-effective strategy if the cost of BCA was $20,906 more than BCS. BCA remained more cost-effective when accounting for follow-up, provided the difference in costs between BCA and BCS was less than $4000 annually. Conclusion: BCA is a cost-effective strategy for patients with early-stage, low-risk, sonographically visible breast cancer when compared to BCS.