AI-based opportunistic CT screening of incidental cardiovascular disease, osteoporosis, and sarcopenia: cost-effectiveness analysis

被引:24
作者
Pickhardt, Perry J. [1 ]
Correale, Loredana [2 ]
Hassan, Cesare [2 ,3 ]
机构
[1] Univ Wisconsin Sch Med & Publ Heatlh, Dept Radiol, 600 Highland Ave, Madison, WI 53792 USA
[2] IRCCS Humanitas Res Hosp, Dept Gastroenterol, Via Manzoni 56, I-20089 Milan, Italy
[3] Humanitas Univ, Dept Biomed Sci, Via R Levi Montalcini 4, I-20072 Milan, Italy
关键词
CT; AI; Opportunistic screening; Body composition; Cost-effectiveness; ABDOMINAL AORTIC CALCIUM; CORONARY-ARTERY CALCIUM; POSTMENOPAUSAL WOMEN; PRIMARY PREVENTION; HEPATIC STEATOSIS; LIAISON SERVICE; STATIN THERAPY; UNITED-STATES; FRACTURE; ASSOCIATION;
D O I
10.1007/s00261-023-03800-9
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose To assess the cost-effectiveness and clinical efficacy of AI-assisted abdominal CT-based opportunistic screening for atherosclerotic cardiovascular (CV) disease, osteoporosis, and sarcopenia using artificial intelligence (AI) body composition algorithms.Methods Markov models were constructed and 10-year simulations were performed on hypothetical age- and sex-specific cohorts of 10,000 U.S. adults (base case: 55 year olds) undergoing abdominal CT. Using expected disease prevalence, transition probabilities between health states, associated healthcare costs, and treatment effectiveness related to relevant conditions (CV disease/osteoporosis/sarcopenia) were modified by three mutually exclusive screening models: (1) usual care ( "treat none "; no intervention regardless of opportunistic CT findings), (2) universal statin therapy ( "treat all " for CV prevention; again, no consideration of CT findings), and (3) AI-assisted abdominal CT-based opportunistic screening for CV disease, osteoporosis, and sarcopenia using automated quantitative algorithms for abdominal aortic calcification, bone mineral density, and skeletal muscle, respectively. Model validity was assessed against published clinical cohorts.Results For the base-case scenarios of 55-year-old men and women modeled over 10 years, AI-assisted CT-based opportunistic screening was a cost-saving and more effective clinical strategy, unlike the "treat none " and "treat all " strategies that ignored incidental CT body composition data. Over a wide range of input assumptions beyond the base case, the CT-based opportunistic strategy was dominant over the other two scenarios, as it was both more clinically efficacious and more cost-effective. Cost savings and clinical improvement for opportunistic CT remained for AI tool costs up to $227/patient in men ($65 in women) from the $10/patient base-case scenario.Conclusion AI-assisted CT-based opportunistic screening appears to be a highly cost-effective and clinically efficacious strategy across a broad array of input assumptions, and was cost saving in most scenarios.
引用
收藏
页码:1181 / 1198
页数:18
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