Wasted indocyanine green (ICG) may be costing hospitals and patients millions of dollars each year, but reducing the size of ICG vials could change that, according to research published in Gynecologic Oncology

Researchers calculated the amount of ICG that is wasted each year in the United States — and the resulting excess costs — when the dye is used for sentinel lymph node (SLN) mapping in patients with endometrial cancer.

The maximum excess annual cost from wasted ICG was more than $3 million for hospitals and more than $17 million for patients. 

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For this study, the researchers used 2020 data from the Surveillance, Epidemiology, and End Results Program database. They identified 65,520 cases of endometrial cancer, including 45,864 patients who were eligible for SLN mapping. Overall, there were 7826 billing records for ICG belonging to 7814 patients.

The researchers assumed that gynecologic oncologists use 2 to 4 mL of the ICG vial kit (25 mg per 10 mL) per case. The team then calculated waste using “cost” as a measure of institutional waste and “charge” as excess cost transferred to patients or payers.

The mean cost of 1 vial of ICG was $99.20, and the mean charge was $482.64. 

The estimated excess annual cost to hospitals from wasted ICG was $2,729,825 if 4 mL of ICG per vial was used and $3,639,767 if 2 mL was used. 

The estimated excess annual charge to patients was $13,308,999 if 4 mL of ICG per vial was used and $17,745,332 if 2 mL was used. 

“To address this issue, we recommend that ICG vials should also be available in a 10 mg vial size,” the researchers wrote. “While this waste is only a fraction of the total annual cost of endometrial cancer in the United States, identifying areas of waste will slow the rising cost of cancer care, particularly as we incorporate effective and novel, but expensive, therapies for our patients.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.  


Marsh LA, Aviki EM, Wright JD, Chen L, Abu-Rustum N, Salani R. Sentinel lymph node mapping for endometrial cancer: Opportunity for medical waste reform. Gynecol Oncol. Published online May 18, 2022. doi:10.1016/j.ygyno.2022.05.008

This article originally appeared on Cancer Therapy Advisor