Cost and Medical Efficiency Analysis of Indocyanine Green Fluorescence-Guided Thoracoscopic Resection of Lung Lesions under the DRG Payment System

To investigate the clinical application value of indocyanine green(ICG) fluorescence-guided thoracoscopic lung lesion resection under the diagnosis related group(DRG) payment system, and to provide reference for the management of new medical technologies in healthcare institutions.

Discharged patients who underwent thoracoscopic segmentectomy and/or wedge resection at Peking Union Medical College Hospital from January 1, 2016 to May 31, 2024 were enrolled. Patients who received ICG fluorescence guidance were assigned to new technology group, while those who did not receive ICG fluorescence guidance were assigned to control group. Operative time, length of stay, cost consumption index, time consumption index, duration of ventilator use, total hospitalization cost, and 10 representative cost items were compared between the two groups. Propensity score matching(PSM) was further used to analyze the changes in these indicators after controlling for confounding factors including age, sex, DRG code, and surgical type.

A total of 7999 patients who met the inclusion and exclusion criteria were enrolled, including 1392 patients(17.4%) in the new technology group and 6607 patients(82.6%) in the control group. Compared with the control group, the new technology group showed significantly shorter operative time and length of stay, and significant reductions in time consumption index, consultation and diagnostic fees, nursing fees, therapeutic medical material fees, bed fees, oxygen therapy fees, antibiotic fees, and albumin product fees, while the cost consumption index, total hospitalization cost, surgical fees, and surgical medical material fees were significantly increased(all P < 0.001). Among EB15(major thoracic surgery without important complications or comorbidities) patients, all indicators except duration of ventilator use, western medicine fees, and duration of invasive mechanical ventilation showed statistically significant differences between the two groups(all P < 0.001). Among patients in EB11(major thoracic surgery with important complications or comorbidities), only albumin product fees were significantly lower in the new technology group than those in the control group(P=0.003), with no statistically significant differences in other indicators(P > 0.05). In patients undergoing wedge resection alone, the new technology group showed significantly shorter operative time and length of hospital stay, as well as significant reductions in time consumption index, consultation and diagnostic fees, nursing fees, therapeutic medical material fees, bed fees, oxygen therapy fees, western medicine fees, antibiotic fees, and albumin product fees, total hospitalization cost and cost consumption index, while surgical medical material fees increased (P < 0.05). After PSM, the operative time in the new technology group was significantly shorter than that in the control group(P=0.022); except for increased western medicine fees, oxygen therapy fees, antibiotic fees, albumin product fees, and therapeutic medical material fees in the new technology group were all significantly lower than those in the control group(all P < 0.05).

ICG fluorescence-guided thoracoscopic lung lesion resection can significantly improve medical efficiency, optimize cost structure, and reduce perioperative supportive resource consumption. However, its clinical benefits vary significantly among patients with different surgical types or different DRG groups, so clinicians are advised to strengthen preoperative precise evaluation.