Budget Impact Analysis of Preoperative Radioactive Seed Localization

Ann Surg Oncol. 2021 Mar;28(3):1370-1378. doi: 10.1245/s10434-020-09071-8. Epub 2020 Sep 1.


Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

MeSH terms

  • Breast Neoplasms* / diagnostic imaging
  • Breast Neoplasms* / radiotherapy
  • Breast Neoplasms* / surgery
  • Female
  • Humans
  • Iodine Radioisotopes / administration & dosage
  • Mastectomy, Segmental
  • Radiopharmaceuticals* / administration & dosage
  • Retrospective Studies


  • Iodine Radioisotopes
  • Radiopharmaceuticals