Validation of a health economics evaluation framework for minimally invasive congenital heart disease clinical pathways: A multi-center disparity analysis

BACKGROUND: Significant regional disparities exist in implementing minimally invasive congenital heart disease (CHD) clinical pathways across China, leading to inefficient resource utilization and increased healthcare costs. METHODS: Using the Sino-CHD registry ( n = 7001 patients from 13 centers), we applied a novel four-domain health economics evaluation framework to assess: (1) medical efficiency (hospitalization duration, intensive care unit stay, and same-day discharge [SDD] rates); (2) treatment-related metrics (surgical duration and transfusion rates); (3) medical quality metrics (mortality and complications); and (4) medical cost (material/drug expenditures). Comparative analyses examined interventional procedures ( n = 4677) versus open surgical ( n = 2324) approaches for atrial/ventricular septal defects and patent ductus arteriosus. RESULTS: Critical disparities emerged that Interventional cohorts demonstrated 20% SDD rates (range: 0%–99.5%), inversely correlating with hospitalization duration ( P < 0.001). Surgical duration varied nearly 4-fold (24.7–86.5 min), while material costs drove 51%–80% of total expenditures (25,979 CNY–40,929 CNY). Open surgery cohorts exhibited 3-fold variation in transfusion rates (0%–75%) and major complications (0%–5.3%). Material costs constituted 55%–74% of total expenses (29,656 CNY–49,097 CNY). Visual analytics revealed preoperative testing completion and SDD adoption as primary modulators of hospitalization duration. CONCLUSIONS: This validated framework quantifies actionable pathway implementation gaps, highlighting cost-containment opportunities through standardized preoperative workflows, blood conservation protocols, and value-based device selection. The system enables targeted quality improvement in the resource-limited settings.