Sentinel lymph node mapping for endometrial cancer: Opportunity for medical waste reform

OBJECTIVE. As healthcare expenditures continue to rise, identifying mechanisms to reduce unnecessary costs is critical. The objective of this study is to estimate the annual cost of wasted indocyanine green (ICG) used for sentinel lymph node mapping in patients with endometrial cancer. METHODS. Using the Surveillance, Epidemiology, and End Results program database and Premier database, we determined the annual number of cases in which sentinel lymph node mapping with ICG would be used and the median cost of ICG to institutions and patients, respectively. We assumed that gynecologic oncologists use 2–4 mL (20–40%) of the currently available ICG vial kit (25 mg per 10 mL) per case. Estimated waste was then calculated using cost as a measure of institutional waste and charge as excess cost transferred to patients or payers. RESULTS. An estimated 45,864 cases of localized endometrial cancer were identified and eligible for sentinel lymph node (SLN) mapping. The mean total cost associated with ICG was 99.20 and the mean charge was $483.64. The estimated excess annual cost to hospitals was $2,729,825 to $3,639,767. Similarly, using mean charge data, the annual cost of wasted drug for patients and payers was $13,308,999 to $17,745,332. CONCLUSIONS. The annual cost of wasted ICG due to its current manufactured vial size exceeds $2 million for hospitals and $13.3–$17.7 million for patients. We suggest ICG vials should be packaged in a 10 mg vial kit (2–4 mL sterile solution) to avoid drug waste and the financial impact to institutions and patients.