Vacuum-Assisted Excision of Breast Lesions: An Analysis of Costs in the Private Healthcare Sector

Introduction: Overdiagnosis and overtreatment have become central issues in the current debate on breast cancer screening and management. Breast cancer remains the most prevalent malignancy among women worldwide, imposing a substantial clinical and economic burden. In this context, vacuum-assisted excision (VAE) has emerged as an effective diagnostic and therapeutic alternative for suspicious breast lesions, offering lower morbidity and potential cost reduction compared with conventional surgery. In Brazil, particularly within the private healthcare sector, national evidence evaluating the direct economic impact of VAE remains scarce. Therefore, this study aimed to analyze the direct costs associated with the use of VAE in the management of suspicious breast lesions in the private healthcare sector. Methods A retrospective cohort study was conducted including women with BI-RADS™ 4 or 5 lesions who were submitted to VAE between 2022 and 2024. A total of 149 patients with complete clinical and pathological data were analyzed. The analysis included medical fees, diagnostic tests, surgical procedures, and costs of special materials. Clinical, radiological, and histopathological variables were evaluated. Results Age, radiological features, and lesion size did not significantly influence overall costs. Prior core needle biopsy and the need for surgery were the main determinants of increased expenses. In the cost-saving group (n = 97), 98.97% of cases were definitively managed with VAE alone, without the need for surgery. In the non–cost-saving group (n = 52), 36.54% of patients underwent surgery. Median total cost in the cost-saving group was USD 1,053.67, while in the non–cost-saving group it reached up to USD 3,140.62. Discussion Vacuum-assisted excision proved to be a highly resolutive, safe, and economically advantageous strategy for the management of suspicious breast lesions in the private healthcare setting. The absence of additional procedures - especially prior core needle biopsy and surgery - was the main factor associated with cost savings. These findings reinforce the role of VAE in reducing surgical overtreatment, optimizing resource allocation, and modernizing breast care delivery. Our results support the systematic incorporation of VAE into clinical protocols within private healthcare, benefiting both patients and healthcare providers.