A cost-effectiveness analysis comparing ultrasound-guided cryoablation and breast-conserving surgery for patients with early-stage, low-risk breast cancer has shown the former to provide comparable health benefit at a lower cost.
Led by Xiao Wu (University of California San Francisco, San Francisco, USA), the research team constructed a Markov decision tree comparing cryoablation and surgery for small (≤1.5cm) unifocal, lymph node negative, ultrasound-visible breast cancer from a payer’s perspective over a five-year period. The result were published in the journal CardioVascular and Interventional Radiology (CVIR).
Outcomes after cryoablation were based on the ICE3 trial led by Richard E Fine (West Cancer Center and Research Institute, Germantown, USA) and those following surgery were based on a meta-analysis published in The Lancet by Sarah Darby (University of Oxford, Oxford, UK) et al. Outcomes were measured in US dollars and quality-adjusted life years (QALYs).
Base case analysis showed cryoablation achieved comparable health outcomes (0.01–0.09 QALY higher) at a lower cost—US$17,682 of cost saving per patient. Probabilistic sensitivity analysis showed cryoablation to be the better strategy in most cases mainly driven by its lower procedural cost; Wu et al describe that surgery in these patients involves operating room time and general anaesthesia, whereas cryoablation can be performed in an office-based setting under local anaesthesia only.
The authors detail that, when varying the annual mortality associated with breast cancer after cryoablation from zero to 10%, surgery became the better strategy when the annual mortality after cryoablation was above 2.1% per year—equivalent to a five-year cancer survival after cryoablation of 90% (ICE3 result: 96.2% at five years). Two-way sensitivity analysis, varying mortality after both surgery and cryoablation, showed that surgery became the more cost-effective strategy if mortality was more than 1.9% lower than that after cryoablation. Cryoablation was the optimal strategy when its local recurrence risk was <51.5% per year.
Wu et al state that cryoablation’s financial benefit will become clearer with more “robust” future analyses which should include younger patients and those with high-risk breast cancers. They hope to gather data on cost and quality of life in multiple countries to help elucidate the cost-effectiveness of ultrasound-guided cryoablation and breast-conserving surgery in various healthcare systems.
