Cost Analysis and Budget Impact Analysis of Indocyanine Green Versus 99mTc Nanocolloid for Sentinel Lymph Node Biopsy in Breast Cancer as Part of a National Implementation Trial
Tessa L. Dinger, Isabelle J. Henskens, Henk J. Schuijt, Jules Lavalaye, Christiaan F. P. van Swol, Annemiek Doeksen, Lea M. DijksmanObjective:
To compare the costs of indocyanine green (ICG) versus technetium-99m-labeled nanocolloid ( 99m Tc) for sentinel lymph node biopsy (SLNB) and to evaluate the economic impact of phased implementation in the Netherlands.
Background:
ICG is an equally effective and safe alternative tracer to 99m Tc for SLNB in breast cancer. Its adoption in surgical practice may reduce healthcare costs.
Methods:
A cost analysis and budget impact analysis (BIA) were performed as part of the INFINITE implementation trial (NCT07146295). Mean per-patient costs were compared between tracers using a priori, model-based cost estimates derived from Dutch healthcare data. The BIA assessed annual and 5-year cost savings to evaluate the economic impact of phased implementation within the Dutch healthcare system. Sensitivity analyses were performed to assess the robustness of model assumptions.
Results:
Implementation of ICG reduced costs by €338 per patient, corresponding to €94,640 in annual hospital savings within the first year for centers performing 280 procedures. Main drivers included the lower cost of preoperative diagnostics for ICG (€21) compared with €258 for 99m Tc, and annual depreciation costs of the near-infrared imaging system (€48) relative to €180 for the SPECT-CT and gamma probe. The BIA projected €11.3 million (95% confidence interval: €−3.1 million to €26.7 million) in national savings over a 5-year period.
Conclusions:
Within the Dutch healthcare system, replacing 99m Tc with ICG for SLNB reduced annual hospital and overall healthcare costs. Although the initial capital investment may pose a barrier, these costs can be recouped within 1 year, supporting broader adoption of ICG in surgical practice.