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Cost comparison of two surgical strategies in the treatment of breast cancer: Sentinel lymph node biopsy versus axillary lymph node dissection

Published online by Cambridge University Press:  01 November 2004

Lionel Perrier ,
Karima Nessah ,
Magali Morelle ,
Hervé Mignotte ,
Marie-Odile Carrère  and
Alain Brémond
Lionel Perrier
Affiliation:
Centre Léon Bérard
Karima Nessah
Affiliation:
Centre Léon Bérard
Magali Morelle
Affiliation:
Centre Léon Bérard
Hervé Mignotte
Affiliation:
Centre Léon Bérard
Marie-Odile Carrère
Affiliation:
Centre Léon Bérard
Alain Brémond
Affiliation:
Centre Léon Bérard
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Abstract

Objectives: The feasibility and accuracy of sentinel lymph node biopsy (SLNB) in the treatment of breast cancer is widely acknowledged today. The aim of our study was to compare the hospital-related costs of this strategy with those of conventional axillary lymph node dissection (ALND).

Methods: A retrospective study was carried out to determine the total direct medical costs for each of the two medical strategies. Two patient samples (n=43 for ALND; n=48 for SLNB) were selected at random among breast cancer patients at the Centre Léon Bérard, a comprehensive cancer treatment center in Lyon, France. Costs related to ALND carried out after SLNB (either immediately or at a later date) were included in SLNB costs (n=18 of 48 patients).

Results: Total direct medical costs were significantly different in the two groups (median 1,965.86€ versus 1,429.93€, p=0.0076, Mann-Whitney U-test). The total cost for SLNB decreased even further for patients who underwent SLNB alone (median, 1,301€). Despite the high cost of anatomic pathology examinations and nuclear medicine (both favorable to ALND), the difference in direct medical costs for the two strategies was primarily due to the length of hospitalization, which differs significantly depending on the technique used (9-day median for ALND versus 3 days for SLNB, p<0.0001).

Conclusions: A lower morbidity rate is favorable to the generalization of SLNB, when the patient's clinical state allows for it. From an economic point of view, SLNB also seems to be preferred, particularly because our results confirm those found in two published studies concerning the cost of SLNB.

Keywords

Breast cancerAxillary lymph node dissectionEconomic evaluationSentinel lymph node biopsy
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 449 - 454
Copyright
© 2004 Cambridge University Press

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