Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’

• Published in: Annals of oncology Vol. 23; no. 5; pp. 1170 - 1177
• Main Authors: Classe, J.M., Baffert, S., Sigal-Zafrani, B., Fall, M., Rousseau, C., Alran, S., Rouanet, P., Belichard, C., Mignotte, H., Ferron, G., Marchal, F., Giard, S., Tunon de Lara, C., Le Bouedec, G., Cuisenier, J., Werner, R., Raoust, I., Rodier, J.-F., Laki, F., Colombo, P.-E., Lasry, S., Faure, C., Charitansky, H., Olivier, J.-B., Chauvet, M.-P., Bussières, E., Gimbergues, P., Flipo, B., Houvenaeghel, G., Dravet, F., Livartowski, A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2012; Oxford University Press
• Subjects: Aged; Algorithms; Antineoplastic agents; Axilla - pathology; axillary lymphadenectomy; Biological and medical sciences; breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - economics; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma - diagnosis; Carcinoma - economics; Carcinoma - pathology; Carcinoma - surgery; cost; Costs and Cost Analysis; Disease Progression; Female; France; General Surgery - organization & administration; Gynecology. Andrology. Obstetrics; Humans; Length of Stay - economics; Length of Stay - statistics & numerical data; Lymph Node Excision - economics; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - diagnosis; Mammary gland diseases; Medical Oncology - organization & administration; Medical sciences; Middle Aged; Neoplasm Staging - economics; Original; Pharmacology. Drug treatments; Prospective Studies; sentinel lymph node; Sentinel Lymph Node Biopsy - economics; Societies, Medical; Tumors; France; Europe; breast cancer; sentinel lymph node; cost; axillary lymphadenectomy; Human; Costs; Breast disease; Sentinel lymph node; Patient; Breast cancer; Malignant tumor; Surgeon; Prospective; Mammary gland diseases; Lymphadenectomy; Treatment; Axillary ganglion; Surgery; Health economy; Early; Economic aspect; Diagnosis; Detection; Comparative study; Cancer; Axillary
• ISSN: 0923-7534; 1569-8041; 1569-8041
• DOI: 10.1093/annonc/mdr355

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€2947 (σ = 580) versus €3331 (σ = 902); P = 0.0001]. ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.