Cost-effectiveness of AI in medicine from a clinical, technical, and economic perspective: A scoping review and a framework of analysis (Preprint)

2021 ◽  
Author(s):  
Jesus Gomez Rossi ◽  
Ben Feldberg ◽  
Joachim Krois ◽  
Falk Schwendicke
Keyword(s):  
Artificial Intelligence ◽  
Cost Effectiveness ◽  
Scientific Literature ◽  
Economic Aspects ◽  
Inclusion Criteria ◽  
Economic Perspective ◽  
Health Policy Analysis ◽  
The Cost ◽  
The Relationship ◽  
Potential Use

BACKGROUND Research and Development (R&D) of Artificial Intelligence (AI) in medicine involve clinical, technical and economic aspects. Better understanding the relationship between these dimensions seems necessary to coordinate efforts of R&D among stakeholders. OBJECTIVE To assess systematically existing literature on the cost-effectiveness of Artificial Intelligence (AI) from a clinical, technical and economic perspective. METHODS A systematic literature review was conducted to study the cost-effectiveness of AI solutions and summarised within a scoping framework of health policy analysis developed to study clinical, technical and economic dimensions. RESULTS Of the 4820 eligible studies, 13 met the inclusion criteria. Internal medicine and emergency medicine were the most studied clinical disciplines. Technical R&D aspects have not been uniformly disclosed in the studies we analysed. Monetisation aspects such as payment models assumed have not been reported in the majority of cases. CONCLUSIONS Existing scientific literature on the cost-effectiveness of AI currently does not allow to draw conclusive recommendations. Further research and improved reporting on technical and economic aspects seem necessary to assess potential use-cases of this technology, as well as to secure reproducibility of results. CLINICALTRIAL Not applicable

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

scholarly journals Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold

2015 ◽  
Vol 19 (14) ◽  
pp. 1-504 ◽  
Author(s):  
Karl Claxton ◽  
Steve Martin ◽  
Marta Soares ◽  
Nigel Rice ◽  
Eldon Spackman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Effects ◽  
The Other ◽  
Opportunity Costs ◽  
Best Estimate ◽  
The Cost ◽  
The Impact ◽  
The Relationship ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

BackgroundCost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.Objectives(1) To provide a conceptual framework to define the cost-effectiveness threshold and to provide the basis for its empirical estimation. (2) Using programme budgeting data for the English NHS, to estimate the relationship between changes in overall NHS expenditure and changes in mortality. (3) To extend this mortality measure of the health effects of a change in expenditure to life-years and to QALYs by estimating the quality-of-life (QoL) associated with effects on years of life and the additional direct impact on QoL itself. (4) To present the best estimate of the cost-effectiveness threshold for policy purposes.MethodsEarlier econometric analysis estimated the relationship between differences in primary care trust (PCT) spending, across programme budget categories (PBCs), and associated disease-specific mortality. This research is extended in several ways including estimating the impact of marginal increases or decreases in overall NHS expenditure on spending in each of the 23 PBCs. Further stages of work link the econometrics to broader health effects in terms of QALYs.ResultsThe most relevant ‘central’ threshold is estimated to be £12,936 per QALY (2008 expenditure, 2008–10 mortality). Uncertainty analysis indicates that the probability that the threshold is < £20,000 per QALY is 0.89 and the probability that it is < £30,000 per QALY is 0.97. Additional ‘structural’ uncertainty suggests, on balance, that the central or best estimate is, if anything, likely to be an overestimate. The health effects of changes in expenditure are greater when PCTs are under more financial pressure and are more likely to be disinvesting than investing. This indicates that the central estimate of the threshold is likely to be an overestimate for all technologies which impose net costs on the NHS and the appropriate threshold to apply should be lower for technologies which have a greater impact on NHS costs.LimitationsThe central estimate is based on identifying a preferred analysis at each stage based on the analysis that made the best use of available information, whether or not the assumptions required appeared more reasonable than the other alternatives available, and which provided a more complete picture of the likely health effects of a change in expenditure. However, the limitation of currently available data means that there is substantial uncertainty associated with the estimate of the overall threshold.ConclusionsThe methods go some way to providing an empirical estimate of the scale of opportunity costs the NHS faces when considering whether or not the health benefits associated with new technologies are greater than the health that is likely to be lost elsewhere in the NHS. Priorities for future research include estimating the threshold for subsequent waves of expenditure and outcome data, for example by utilising expenditure and outcomes available at the level of Clinical Commissioning Groups as well as additional data collected on QoL and updated estimates of incidence (by age and gender) and duration of disease. Nonetheless, the study also starts to make the other NHS patients, who ultimately bear the opportunity costs of such decisions, less abstract and more ‘known’ in social decisions.FundingThe National Institute for Health Research-Medical Research Council Methodology Research Programme.

Role of TQM in Sustained Business Performance in Indian Automotive Supply Chain

2018 ◽  
pp. 121-143 ◽  
Author(s):  
Sanjiv Narula ◽  
Satwinder Pal ◽  
Vinay Saini ◽  
Prabhat Saxena ◽  
Ajay Goyal ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Business Performance ◽  
Primary Data ◽  
Total Quality ◽  
Business Sustainability ◽  
Automotive Supply Chain ◽  
The Cost ◽  
Automotive Supply ◽  
The Relationship

This chapter creates a place in which TQM (total quality management) differs from business sustainability. Management can focus themselves more accurately when they understand the missing link between these two aspects. It also helps to reduce and eliminate certain wastes related to cost and efficiency and helps to produce better quality with minimum waste. In this study, a TQM framework is developed according to a comprehensive literature review: primary data collection through a structured questionnaire and interview of performers/nonperformers at various levels in different organizations. Analysis of data is used to establish the relationship between attributes of TQM and business sustainability. TQM enhances the cost effectiveness while helping suppliers to produce enhanced quality to their customers and with minimum efforts and lesser rejection. Analysis of data is used to establish the relationship between attributes of TQM and cost effectiveness in an organization.

scholarly journals The Usefulness of Diffusion Tensor Tractography in Diagnosing Neuropathic Pain: A Narrative Review

2021 ◽  
Vol 15 ◽  
Author(s):  
Seoyon Yang ◽  
SuYeon Kwon ◽  
Min Cheol Chang
Keyword(s):  
Neuropathic Pain ◽  
Brain Injuries ◽  
Diffusion Tensor ◽  
Diffusion Tensor Tractography ◽  
Pathophysiological Mechanism ◽  
Inclusion Criteria ◽  
Pathophysiological Process ◽  
Pubmed Search ◽  
The Relationship ◽  
Potential Use

Diffusion tensor tractography (DTT) is derived from diffusion tensor imaging. It has allowed visualization and estimation of neural tract injury, which may be associated with the pathogenesis of neuropathic pain (NP). The aim of the present study was to review DTT studies that demonstrated the relationship between neural injuries and NP and to describe the potential use of DTT in the evaluation of neural injuries that are involved in the pathophysiological process of NP. A PubMed search was conducted for articles published until July 3, 2020, which used DTT to investigate the association between neural injuries and NP. The key search phrase for identifying potentially relevant articles was (diffusion tensor tractography AND pain). The following inclusion criteria were applied for article selection: (1) studies involving patients with NP and (2) studies in which DTT was applied for the evaluation of NP. Review articles were excluded. Altogether, 108 potentially relevant articles were identified. After reading the titles and abstracts and assessment of eligibility based on the full-text articles, 46 publications were finally included in our review. The results of the included studies suggested that DTT may be beneficial in identifying the pathophysiological mechanism of NP of various origins including central pain caused by brain injuries, trigeminal neuralgia, sciatica, and some types of headache. Further studies are needed to validate the efficacy of DTT in investigating the pathophysiology of other types of NP.

scholarly journals Cost-effectiveness of Artificial Intelligence for Proximal Caries Detection

2020 ◽  
pp. 002203452097233
Author(s):  
F. Schwendicke ◽  
J.G. Rossi ◽  
G. Göstemeyer ◽  
K. Elhennawy ◽  
A.G. Cantu ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Cost Effectiveness ◽  
False Negative ◽  
Sensitivity Analyses ◽  
Caries Detection ◽  
Base Case ◽  
Case Scenario ◽  
Proximal Caries ◽  
The Cost ◽  
Tooth Retention

Artificial intelligence (AI) can assist dentists in image assessment, for example, caries detection. The wider health and cost impact of employing AI for dental diagnostics has not yet been evaluated. We compared the cost-effectiveness of proximal caries detection on bitewing radiographs with versus without AI. U-Net, a fully convolutional neural network, had been trained, validated, and tested on 3,293, 252, and 141 bitewing radiographs, respectively, on which 4 experienced dentists had marked carious lesions (reference test). Lesions were stratified for initial lesions (E1/E2/D1, presumed noncavitated, receiving caries infiltration if detected) and advanced lesions (D2/D3, presumed cavitated, receiving restorative care if detected). A Markov model was used to simulate the consequences of true- and false-positive and true- and false-negative detections, as well as the subsequent decisions over the lifetime of patients. A German mixed-payers perspective was adopted. Our health outcome was tooth retention years. Costs were measured in 2020 euro. Monte-Carlo microsimulations and univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability at different willingness-to-pay thresholds were quantified. AI showed an accuracy of 0.80; dentists’ mean accuracy was significantly lower at 0.71 (minimum–maximum: 0.61–0.78, P < 0.05). AI was significantly more sensitive than dentists (0.75 vs. 0.36 [0.19–0.65]; P = 0.006), while its specificity was not significantly lower (0.83 vs. 0.91 [0.69–0.98]; P > 0.05). In the base-case scenario, AI was more effective (tooth retention for a mean 64 [2.5%–97.5%: 61–65] y) and less costly (298 [244–367] euro) than assessment without AI (62 [59–64] y; 322 [257–394] euro). The ICER was −13.9 euro/y (i.e., AI saved money at higher effectiveness). In the majority (>77%) of all cases, AI was less costly and more effective. Applying AI for caries detection is likely to be cost-effective, mainly as fewer lesions remain undetected. Notably, this cost-effectiveness requires dentists to manage detected early lesions nonrestoratively.

scholarly journals Estimating influenza-related hospitalization in the Netherlands

1998 ◽  
Vol 121 (1) ◽  
pp. 129-138 ◽  
Author(s):  
R. M. P. M. BALTUSSEN ◽  
A. REINDERS ◽  
M. J. W. SPRENGER ◽  
M. J. POSTMA ◽  
J. C. JAGER ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cost Effectiveness ◽  
The Netherlands ◽  
Hospital Discharge ◽  
Economic Perspective ◽  
Discharge Rates ◽  
The Cost ◽  
The Impact

The purpose of this study was to examine the impact of influenza on hospitalization in the Netherlands. Two methods were applied to estimate this effect: (a) regression analysis and (b) comparison of hospitalization in epidemic years with non-epidemic years. Hospital discharge rates in 1984–93 have been considered. The study shows that, during the period studied, on average, almost 2700 people were hospitalized for influenza per annum, and that influenza was diagnosed as the main cause for hospitalization in only a fraction of these hospitalizations (326: 12%). From an economic perspective, these results imply that the cost-effectiveness of vaccination against influenza may be severely underestimated when looking only at changes achieved in the number of hospitalizations attributed to influenza.

The Cost-Effectiveness of Oral Triptan Therapy in Sweden

Cephalalgia ◽  
2007 ◽  
Vol 27 (1) ◽  
pp. 54-62 ◽  
Author(s):  
J Ramsberg ◽  
M Henriksson
Keyword(s):  
Cost Effectiveness ◽  
Scientific Literature ◽  
Cost Effective ◽  
Base Case ◽  
Migraine Treatment ◽  
Base Case Analysis ◽  
Effectiveness Model ◽  
Meta Analyses ◽  
The Cost ◽  
Substantial Uncertainty

The literature suggests that triptans are cost effective compared with older types of migraine treatment. However, which of the triptans that is most cost effective has not been established. We compared the costs and effects of triptan treatment from a Swedish societal perspective, using evidence from the literature. A probabilistic cost-effectiveness model was constructed to investigate the costs and effects of treating a single attack in a typical migraine patient. The end-point used in the base-case analysis was sustained pain free without any adverse events (SNAE). We searched the scientific literature for meta-analyses reporting the efficacy of oral triptans. All treatments except rizatriptan 10 mg and eletriptan 40 mg were dominated. The incremental cost per SNAE of rizatriptan 10 mg compared with eletriptan 40 mg was approximately €100. There was substantial uncertainty concerning the results, but probabilistic analysis showed that rizatriptan 10 mg and eletriptan 40 mg had the highest probability of being cost-effective.

Cost of multiple sclerosis by level of disability: a review of literature

2005 ◽  
Vol 11 (2) ◽  
pp. 232-239 ◽  
Author(s):  
M B Patwardhan ◽  
D B Matchar ◽  
G P Samsa ◽  
D C McCrory ◽  
R G Williams ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Indirect Costs ◽  
Review Of Literature ◽  
Inclusion Criteria ◽  
Economic Literature ◽  
Important Conclusion ◽  
Disability Status ◽  
The Cost ◽  
The Relationship ◽  
Selection Of

We performed a review of the economic literature to identify what is known about the relationship between Expanded Disability Status Scale (EDSS) categories and cost of multiple sclerosis (MS). We sought cohort studies of patients with multiple sclerosis that described the costs attributed to each EDSS score and utilized specific inclusion criteria for the selection of 10 studies. We found that both direct and indirect costs rise continuously with increasing EDSS category, and this rise is qualitatively exponential. The rise in indirect costs appears at lower EDSS scores. The cost of a relapse occurring in any given EDSS category exceeds that associated with that particular EDSS category. Few studies comprehensively assessed the entire spectrum of the costs, and much of the literature is based on EDSS categories in coarse groupings. In spite of several variations between studies, one important conclusion that we can draw is that rise in cost is positively correlated to scores on the EDSS categories, and therefore agents with a capacity to prevent or arrest the rate of MS progression may affect the overall cost of MS.

scholarly journals Triage of Persons With Tuberculosis Symptoms Using Artificial Intelligence–Based Chest Radiograph Interpretation: A Cost-Effectiveness Analysis

2021 ◽  
Vol 8 (12) ◽  
Author(s):  
Ntwali Placide Nsengiyumva ◽  
Hamidah Hussain ◽  
Olivia Oxlade ◽  
Arman Majidulla ◽  
Ahsana Nazish ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Cost Effectiveness ◽  
Chest Radiograph ◽  
Smear Microscopy ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Current Standard ◽  
Life Years ◽  
Microbiological Testing ◽  
The Cost

Abstract Background In settings without access to rapid expert radiographic interpretation, artificial intelligence (AI)–based chest radiograph (CXR) analysis can triage persons presenting with possible tuberculosis (TB) symptoms, to identify those who require additional microbiological testing. However, there is limited evidence of the cost-effectiveness of this technology as a triage tool. Methods A decision analysis model was developed to evaluate the cost-effectiveness of triage strategies with AI-based CXR analysis for patients presenting with symptoms suggestive of pulmonary TB in Karachi, Pakistan. These strategies were compared to the current standard of care using microbiological testing with smear microscopy or GeneXpert, without prior triage. Positive triage CXRs were considered to improve referral success for microbiologic testing, from 91% to 100% for eligible persons. Software diagnostic accuracy was based on a prospective field study in Karachi. Other inputs were obtained from the Pakistan TB Program. The analysis was conducted from the healthcare provider perspective, and costs were expressed in 2020 US dollars. Results Compared to upfront smear microscopy for all persons with presumptive TB, triage strategies with AI-based CXR analysis were projected to lower costs by 19%, from $23233 per 1000 persons, and avert 3%–4% disability-adjusted life-years (DALYs), from 372 DALYs. Compared to upfront GeneXpert, AI-based triage strategies lowered projected costs by 37%, from $34346 and averted 4% additional DALYs, from 369 DALYs. Reinforced follow-up for persons with positive triage CXRs but negative microbiologic tests was particularly cost-effective. Conclusions In lower-resource settings, the addition of AI-based CXR triage before microbiologic testing for persons with possible TB symptoms can reduce costs, avert additional DALYs, and improve TB detection.

The cost-effectiveness of algorithms and artificial intelligence applied in health care: A scoping review research protocol (Preprint)

2019 ◽  
Author(s):  
Stephanie Aboueid ◽  
Rebecca Hsin-Ling Liu ◽  
Piraveena Sabesan
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Cost Effectiveness ◽  
Scoping Review ◽  
Evidence Based Practice ◽  
Data Extraction ◽  
Future Research ◽  
Evidence Based ◽  
Review Protocol ◽  
The Cost

BACKGROUND Given the rapid digitization of health care and abundance of available data, there is a great interest in how to leverage these advancements into evidence-based practice. Algorithms and artificial intelligence have the potential to improve health care, reduce costs, and contribute to evidence-based practice. An in-depth examination of the available evidence is needed to elucidate the cost-effectiveness of algorithms and AI techniques applied in health care. OBJECTIVE The goal of this scoping review will be to map the literature on the cost-effectiveness of algorithms and AI techniques applied in health care. The current review protocol provides an overview of the steps taken to complete the review. METHODS The PRISMA-Scoping Review checklist will be used to guide the reporting of the scoping review. Three main concepts include: 1) health care costs; 2) algorithms and AI techniques; and 3) cost-effectiveness analysis. The following databases will be used: PubMed, Scopus, ACM Digital Library, IEEE, Google Scholar, Econlit, OpenGrey, and ProQuest Dissertations and Theses. Two researchers (SA and RHL) will independently screen the titles, abstracts, and full texts, while a third researcher (PS) will negotiate any discrepancies, until consensus is reached. RESULTS Article retrieval, data extraction, and interpretation are currently underway. CONCLUSIONS Findings from the review may provide invaluable insights on the cost-effectiveness of algorithms and AI techniques applied in health care. Given that health care dollars are scarce, it is important to know which algorithms and AI techniques are worth the upfront investments. As a result, decision-makers will be able to identify which algorithms or AI technique would be of value for their specific context. This review will also identify key knowledge gaps in the literature and will provide next steps for future research. CLINICALTRIAL Not applicable - this is a scoping review.

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