Background: Wire localisation (WL) is the gold standard localisation technique for wide local excision (WLE) of non-palpable breast lesions but has disadvantages that have led to the development of wireless techniques. This study compared the cost-effectiveness of radar localisation (RL) to WL. Methods: This was a single-institution study of 110 prospective patients with early-stage breast cancer undergoing WLE using RL with the SCOUT® Surgical Guidance System (2021-2023) compared with a cohort of 110 patients using WL. Margin status, re-excision rates, and surgery delays associated with preoperative localisation were compared. Costs from a third-party payer perspective in Australian dollars (AUD$) calculated using micro-costing, break-even point, and cost-utility analyses. Clinical trial registration: ACTRN12624000068561. Results: One-hundred-ten WLEs using RL cost a total of AUD$402,281, in addition to the device cost of AUD$77,150. The average additional cost of a surgery delay was AUD$2318. Use of RL reduced the surgery delay rate by 10% (p=0.029), preventing 11 delays with cost savings of AUD$25,496. No differences were identified in positive margin rates (RL:11.8% versus WL:17.3%, p=0.25) or re-excision rates (RL:14.5% versus WL:21.8%, p=0.221). Two-hundred-ninety RL cases are needed to break-even. The cost of each WLE using RL was greater than WL by AUD$567. There was a greater clinical benefit of 1.15 quality-adjusted life-years (QALYs) and an incremental cost-utility ratio of AUD$493 per QALY favouring RL. Conclusions: Routine use of RL was a more cost-effective intervention than WL. Close to 300 RL cases are likely needed to be performed to recover costs of the medical device.