Cost-effectiveness analysis of different tracers (Patent Blue, Technetium-99 m, and Indocyanine Green) for Sentinel Lymph Node Biopsy procedure in breast cancer.

Abstract

Sentinel Lymph Node (SLN) mapping is a highly accurate method for assessing axillary status in breast cancer, using various tracers such as Patent Blue, Technetium-99 m, Indocyanine Green, and Superparamagnetic Iron Oxide Nanoparticles. Despite its efficacy, there is limited literature on the costs of these procedures, prompting this study. The objective was to conduct a micro-costing and cost-effectiveness analysis of Sentinel Lymph Node Biopsy (SLNB) using Patent Blue (BD), Technetium-99 m (99mTc), and Indocyanine Green (ICG), estimating costs for a nonprofit institution over time. An economic evaluation using microcosting, cost-effectiveness, and financial impact analysis calculated direct medical and non-medical costs for approximately 100 procedures. The sensitivity analysis varied costs by ± 20%. Results showed the cost per procedure as US$ 67.71 for BD, US$ 88.31 for 99mTc, and US$ 134.98 for ICG, leading to annual costs of US$ 6,771.50, US$ 8,831.09, and US$ 13,498.38, respectively. For institutions with a Nuclear Center, 99mTc is more cost-effective than ICG, which incurs an additional US$ 51.48 per extra unit of effect with similar migration rates (96.5% vs. 97.3%). For institutions without a Nuclear Center, ICG is recommended over BD, despite an additional US$ 58.34 per unit of effect, due to a higher tracer migration rate (97.3% vs. 87.5%). Technetium-99 m is the preferred tracer for institutions with a Nuclear Medicine center due to its cost-effectiveness, offering higher accuracy and lower costs compared to Indocyanine Green, while Patent Blue, though cheaper, may lead to additional treatment costs due to its lower accuracy.