Abstract

Purpose: With the extent of breast tissue manipulation using oncoplastic surgical techniques, there lies a challenge in marking the tumor bed for adjuvant radiation therapy planning. Two competing techniques in doing so exist and involve the traditional placement of surgical clips in the surgical tumor bed or the newer technique of placing a Biozorb marker in the tumor bed. Our goal was to perform a cost-utility assessment to see which tumor bed marking approach is more cost-effective. Based on device list prices and clinical outcomes from a comprehensive literature review, we assessed if an approach either dominated or had an incremental cost-utility ratio of less than $50,000/QALY since either would signify cost-effectiveness. Results: From a cost comparison, the Biozorb marker ($1250) was far costlier than the clip applier device ($50). Our PRISMA search (Figure 1) reviewed 133 articles for clip placement and 42 articles for Biozorb placement in oncoplastic surgery with 2 clip placement articles and 3 Biozorb articles meeting criteria. The available data for either marking technique suggests reasonable tumor bed identification for adjuvant radiation treatment without clear clinical advantages supporting one technique over the other. Overall clinical equivalence in the setting of a clear cost advantage suggests dominant cost-effectiveness in favor of clips. Conclusion: Using surgical clips to identify the tumor bed in oncoplastic surgery is dominant and more cost-effective over the Biozorb technique as clips are relatively inexpensive while both techniques reasonably identify the tumor bed.

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