The impact of sentinel node biopsy and axillary staging strategy on hospital costs

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Abstract
Background: The aim of the study was to evaluate total hospital costs of three different sentinel node biopsy (SNB) protocols compared to those of diagnostic axillary lymph node dissection (ALND). Patients and methods: The study included 237 consecutive breast cancer patients who underwent SNB with frozen section diagnosis. The sequence of the treatment procedures for each patient was recorded. The sequences of treatment procedures for the same patients were evaluated using three hypothetical scenarios: diagnostic ALND, SNB without frozen section diagnosis and SNB as day case surgery prior to the breast operation. The total hospital costs were calculated in all protocols. Results: The hospital costs per patient were 3750€. The hospital costs per patient would have been 3020€ when using the ALND model, 4087€ had the frozen section not been applied and 4573€ using ‘SNB as day case surgery’ model. The costs with or without frozen section diagnosis would have been equal with a threshold false negative rate of 35%. Conclusions: SNB seems to be associated with higher hospital costs than diagnostic ALND. Frozen section diagnosis seems to be worthwhile as long as the false negative rate is <35%.