SynthesisJournal of surgical oncology2026
Cost-Utility Analysis of Indocyanine Green Versus Methylene Blue for Sentinel Lymph Node Biopsy in Breast Cancer.
Synthesis in Journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundSentinel lymph node biopsy (SLNB) is commonly used for axillary staging in breast cancer surgery. Traditional localization methods include technetium-99m, lymphazurin, methylene blue (MB), or a combination of these. Indocyanine green (ICG) is a safe and effective alternative with fewer complications. We compared the cost-effectiveness of ICG and MB for SLNB in breast cancer.
methodsA systematic PubMed review identified the success and complication rates for MB and ICG. Costs of successful breast cancer surgeries with SLNB and related complications were estimated using Centers for Medicare & Medicaid Services (CMS) rates via Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) codes. Published utility scores were used to calculate quality-adjusted life years (QALYs). A decision tree model was developed to determine the incremental cost-effectiveness ratio (ICER). One-way (deterministic) and Monte Carlo (probabilistic) sensitivity analyses were performed to assess uncertainty. The willingness-to-pay (WTP) threshold was set to $50,000/QALY.
resultsSLNB using ICG cost $287 more than MB but gained 0.07 QALY, resulting in an ICER of $4,044.44, well below the WTP threshold. Sensitivity analysis showed SLNB with ICG became cost-ineffective if the probability of complication exceeded 4.9% or if ICG costs exceeded $4,190 per vial. SLNB with MB became cost-effective if the likelihood of complications dropped below 2.6%. Monte Carlo analysis indicated an 80% probability that SLNB with ICG is the more cost-effective option.
conclusionsGiven lower complication rates despite higher upfront cost, ICG proved more cost-effective than MB in SLNB for breast cancer due to its improved quality-adjusted outcomes.
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