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

[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.