Cost-effectiveness Analysis of Image-Guided System in Functional Endoscopic Sinus Surgery: A Retrospective Chart Review Study in China

Background: Image-guided system (IGS) has been gradually applied in the field of rhinology, making functional endoscopic sinus surgery (FESS) a truly minimally invasive and precise surgery. This study was based on real-world data from China hospitals and aimed to evaluate the cost-effectiveness of the IGS navigation system in FESS. Methods: : This was a two-center retrospective chart review of patients with chronic rhinosinusitis who underwent FESS, including open frontal sinus between July 1, 2018 and December 31, 2019 in China. The intervention group consisted of 100 patients who underwent FESS with the IGS navigation system (IGS group), and the control group consisted of 100 patients who underwent conventional FESS (Non-IGS group). Data were collected from surgical notes and hospital medical records. The primary endpoints for clinical effectiveness and safety were rehospitalization rate due to bleeding, reoperation rate due to bleeding, and reoperation rate due to recurrence. Results: : There were no cases of rehospitalization due to bleeding, reoperation due to bleeding, and reoperation due to recurrence in the IGS group. In the non-IGS group, there were four cases of rehospitalization due to bleeding; all four patients underwent hemostasis surgery with an incidence of 4.00% (P=0.121). No cases of reoperation due to recurrence were in the non-IGS group. The total hospitalization cost was 17,391.51 CNY in the IGS group and 17,538.13 CNY in the non-IGS group per patient, with no statistical difference between the two groups (P=0.715). Compared with the non-IGS group, the IGS group had an overall cost saving of 146.62 CNY per patient. Although the procedure-related medical costs of IGS group were increased by 1,286.12 CNY compared with the non-IGS group, this was more than offset by other costs. Conclusion: The results of the study indicated that the IGS may reduce occurrence of rehospitalization and reoperation due to postoperative bleeding. Although the use of navigation technology increased the cost of surgery, its clinical effectiveness brought other medical cost savings, resulting in no significant difference in the overall cost of navigation surgery compared to conventional surgery. The IGS should be considered cost-effectiveness in the treatment of FESS.