Avoid complications
Fewer leaks, tissue-necrosis events and unplanned returns to theatre.
HEALTH ECONOMICS Economic Evidence
IC-Flow™ Imaging System and the Economics of Better Surgical Decision-Making
ICG fluorescence imaging provides information while the surgical plan can still be changed. Its health-economic value is clearest where better intraoperative assessment helps prevent a costly complication, avoids a return to theatre or improves operating-room efficiency.
OUTCOMES THAT MATTER
Seeing more during surgery can mean spending less after it.
31%
relative reduction in colorectal anastomotic leaks in an RCT-only meta-analysis
$1,424
lower lifetime cost per colorectal patient in a health-technology assessment
60%
lower odds of reoperation in breast reconstruction
$1,235
modelled lifetime saving per laparoscopic cholecystectomy
CLINICAL & ECONOMIC VALUE
Four routes to healthcare value
Reduce resource use
Fewer additional bed-days, readmissions and complex interventions.
Improve workflow
Real-time visual information without ionising radiation.
Increase utilisation
One portable platform supporting multiple
applications and specialties.
Evidence statement: the statistics on these pages relate to ICG fluorescence imaging and to the specific systems, procedures and assumptions used in the cited studies. They are not claims of equivalent outcomes with IC-Flow in every setting.
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OUTCOMES THAT MATTER
Seeing more during surgery can mean spending less after it.
29 fewer
clinical leaks per 1,000 colorectal procedures
7.3 days
additional hospital stay associated with a colorectal anastomotic leak
$24,129
additional hospital cost associated with a leak
$28.6m
additional cost per 1,000 colorectal patients when leaks and readmissions are included
69%
lower odds of fat necrosis in breast reconstruction
42%
lower odds of mastectomy skin-flap necrosis
29 fewer leaks × $24,129 per leak ≈ $700,000
IN PRACTICE
What these numbers mean
The strongest health-economic argument is not that fluorescence imaging adds another image. It is that information is available before closure-when inadequate perfusion can still be addressed or anatomy can still be clarified.
The financial effect will vary by hospital and will need to take into account baseline complication rates, procedure mix, equipment utilisation, local bed-day costs and whether management tracks health economic metrics. For that reason, the most credible business case combines published evidence with the hospital’s own costs and volumes.
A practical hospital calculation
Illustrative example-not a clinical claim:
at 1,000 colorectal procedures, 29 fewer leaks multiplied by an incremental cost of $24,129 equates to approximately $700,000 in potentially avoided index-admission costs before the cost of fluorescence imaging is deducted. The two inputs come from separate studies and should be replaced with local figures for a hospital-specific budget-impact model.
Visualisation of Blood Flow
Perfusion assessment has the clearest evidence of direct cost avoidance.
Colorectal surgery: preventing a high-cost leak
4.5% 5%
anastomotic-leak rate with and without ICG fluorescence angiography
Numbers Needed to Treat (NNT): 23
patients assessed to prevent one leak in the same meta-analysis
8.4%
of cases prompted a change in surgical plan
192
modelled saving per colorectal case
A newer RCT-only synthesis reported a 31% relative reduction-29 fewer clinical leaks per 1,000 procedures-with moderate-certainty evidence. A separate cost model found routine ICG fluorescence angiography to be cost-saving under conservative assumptions and calculated a saving of $192.22 per case.
When did the colorectal model remain cost-saving?
Breast reconstruction: fewer complications and returns to theatre
60%
lower odds of reoperation
69%
lower odds of fat necrosis
$614
reported saving per patient
$1,893 – $5,162
saving per flap-necrosis case prevented in selected high-risk groups
The model remained cost-saving when the cost of a leak exceeded $5,616, fluorescence imaging cost less than $634 per use, the baseline leak rate exceeded 4.9%, or the odds ratio for leak reduction was below 0.69. 7
Visualisation of Bile Ducts
The value proposition combines a high-volume procedure with faster surgery and the potential avoidance of a rare, serious complication.
$1,235
modelled lifetime saving per patient
21.2 min
shorter operative duration in the model inputs
1.62% 6.7%
of cases prompted a change in surgical plan
98.83%
of model simulations found fluorescence both more effective and less costly
THE ECONOMIC CASE
Why a small improvement can matter
Cholecystectomy is performed at very high volume. Bile duct injury occurs in only a small proportion of procedures, but its consequences can include complex reconstruction, repeated interventions, long-term follow-up and substantial legal and societal costs.
A published cost-effectiveness model found fluorescent cholangiography to be less costly and more effective than bright-light laparoscopic cholecystectomy. Importantly, the modelled saving was driven by shorter operating time and fewer conversions to open surgery-not by assuming fewer bile duct injuries.
Improved visualisation of biliary anatomy is supported. A reduction in bile duct injury has not been established conclusively. The $1,235 figure is a modelled US saving, not a result from a randomised clinical trial. Most published economic evidence is from laparoscopic cholecystectomy and is not IC-Flow-specific; IC-Flow communications must remain within the current market-specific intended purpose.
The cost of bile duct injury
An older Swedish cost analysis estimated the total societal cost of minor and major bile duct injuries at €473,690–€608,789 per million inhabitants each year, including hospital care, sick leave and lost production. The figures are historical, but they illustrate why prevention and earlier recognition remain economically important. 10
REFERENCES
1. Shapera E, et al. Indocyanine green fluorescence-guided perfusion vs standard assessment to prevent clinical anastomotic leak after colorectal resection: a GRADE-assessed systematic review and meta-analysis of randomised controlled trials. World Journal of Surgical Oncology. 2025;23. doi:10.1186/s12957-025-04163-9.
2. Ontario Health. Indocyanine Green Fluorescence Imaging for Colorectal Surgery: A Health Technology Assessment. Ontario Health Technology Assessment Series. 2025. The primary economic evaluation reported 0.07 additional QALYs and costs lower by C$1,424.
3. Singaravelu A, et al. Clinical and cost-effectiveness of intraoperative flap perfusion assessment with indocyanine green fluorescence angiography in breast and head and neck reconstructions: a systematic review and meta-analysis. Microsurgery. 2024. doi:10.1002/micr.31250.
4. Reeves JJ, et al. The price is right: routine fluorescent cholangiography during laparoscopic cholecystectomy. Surgery. 2022;171(5):1168–1176. PMID:34952715.
5. Hammond J, Lim S, Wan Y, Gao X, Patkar A. The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes. Journal of Gastrointestinal Surgery.
2014;18:1176–1185. doi:10.1007/s11605-014-2506-4.
6. Johnston SS, et al. Impact of indocyanine green fluorescence angiography on surgeon action and anastomotic leak in colorectal resections: a systematic review and meta-analysis. Surgical Endoscopy. 2025. doi:10.1007/s00464-025-11582-y.
7. Liu J, et al. Cost analysis of indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery. Surgical Endoscopy. 2022. PMID:35290507.
8. Duggal CS, Madni T, Losken A. An outcome analysis of intraoperative angiography for
postmastectomy breast reconstruction. Aesthetic Surgery Journal. 2014;34(1):61–65.
9. Kanuri A, Liu AS, Guo L. Whom should we SPY? A cost analysis of laser-assisted indocyanine green angiography in prevention of mastectomy skin flap necrosis during prosthesis-based breast reconstruction. Plastic and Reconstructive Surgery. 2014. PMID:24675199.
10. Andersson R, Eriksson K, Blind PJ, Tingstedt B. Iatrogenic bile duct injury-a cost analysis. HPB. 2008;10(6):416–419. doi:10.1080/13651820802140745.
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