Budget Impact Analysis of Preoperative Radioactive Seed Localization



This study models costs in implementing a radioactive seed localization (RSL) program for nonpalpable breast lesions at a large Canadian tertiary hospital to replace existing wire-guided localization (WGL).


All direct and indirect operating costs of localization per lesion from the hospital’s perspective were determined by retrospectively reviewing patient data and costs from January 2014 to December 2016. A budget impact analysis and sensitivity analysis were performed to calculate the mean cost per lesion, the minimum and maximum cost per lesion, operational costs, and initial costs.


There were 265 WGL lesions in 2014 and 170 RSL lesions in 2016 included in cost calculation. The mean cost per localization was $185 CAD for WGL ($148–$311) and $283 CAD ($245–$517) for RSL using preloaded seeds, adjusted to 2016 Canadian dollars. The annual operational expenditure including all localizations and overhead costs was $49,835 for WGL and $80,803 for RSL. Initial costs for RSL were $22,000, including external training and new equipment purchases.


Our budget impact analysis shows that RSL using preloaded radioactive seeds was more expensive than WGL when considering per-lesion localization costs and specific costs related to radiation safety. Manually loading radioactive seed could be a cost-saving alternative to purchasing preloaded seeds. Our breakdown of costs can provide a framework for other centres to determine which localization method best suit their departments.

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The authors acknowledge Cindy Matheson, radiation safety officer, and Curtis Caldwell at Sunnybrook Health Sciences Centre for providing information on radiation safety. We also acknowledge breast imaging and breast surgery department at Sunnybrook Health Sciences Centre for their expertise.

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Correspondence to Wyanne Law MD.

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Nicole Look Hong is a consultant to MOLLI Surgical—creates a competing product for the localization products described in this paper. Ananth Ravi is a consultant to MOLLI Surgical -- co-author of the MOLLI patent. Frances Wright is the Temerty Chair in Breast Cancer funded by the Temerty Family. The Temerty family also supports magnetic seed commercialization developed at Sunnybrook Research Institute.

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Law, W., Look Hong, N., Ravi, A. et al. Budget Impact Analysis of Preoperative Radioactive Seed Localization. Ann Surg Oncol 28, 1370–1378 (2021). https://doi.org/10.1245/s10434-020-09071-8

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