OBJECTIVES: Due to Covid-19 pandemic, the standard surgical otolaryngology activity was impacted in terms of operating room (OR) and staff availability, with a decrease in the number of sinus procedures and a consequential increase in the waiting lists.

The Sinus Rapid Relief Pathway (SRRP) is designed to quickly guarantee patient access to surgery in the most appropriate care setting.

This analysis aimed to show the economic implications of adopting SRRP compared to the Standard of Care (SoC), from an Italian hospital and National HealthCare System (NHS) perspective.

METHODS: A Microcosting analysis was performed. The patient pathway (PP) and the hospital direct costs were assessed by a Key Opinion Leader, and they were associated with three groups of procedures septoplasty, functional endoscopic sinus surgery (FESS), and balloon dilation techniques (BDT) to open up the sinus drainage; three different settings were considered: the SoC, that is general anesthesia (GA) performed in the OR, vs the local anesthesia called also awake surgery (AS) performed in OR, and in the outpatient setting (OS). The last two are both considered part of SRRP. A comparison between costs and reimbursement was done.

RESULTS: Septoplasty direct costs are: €1,175 in GA-OR; €756 in AS-OR; €527 in AS-OS. It is reimbursed with the DRG 55 with an average national tariff of €1,465 (day-surgery). FESS direct costs are: €2,037 in GA-OR; €897 in AS-OR; €704 in AS-OS. BDT direct costs are: €2,369 in GA-OR; €1,604 in AS-OR; €1,395 in AS-OS. Both FESS and BDT are reimbursed with the DRG 53 with a tariff of €2,539 (ordinary recovery) for the GA-OR, and a tariff of €2.070 (day-surgery) for AS-OR and the AS-OS.

CONCLUSIONS: SRRP performed on the most appropriate target population reduces the duration of procedures, hospital length of stay, waiting lists, and patient management costs by optimizing resource consumption.