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AI-based opportunistic CT screening of incidental cardiovascular disease, osteoporosis, and sarcopenia:
Perry J Pickhardt1, Loredana Correale2, Cesare Hassan2,3
1Department of Radiology, University of Wisconsin School of Medicine & Public Heatlh, 600 Highland Ave, Madison, WI, 53792, USA. ppickhardt2@uwhealth.org.
Insights
AI-assisted opportunistic screening using abdominal CT scans is a cost-effective strategy for detecting cardiovascular disease, osteoporosis, and sarcopenia. This approach offers significant clinical benefits and cost savings compared to standard care or universal treatment.
Area of Science:
- Radiology and Medical Imaging
- Artificial Intelligence in Healthcare
- Preventive Medicine
Background:
- Abdominal CT scans can reveal incidental findings related to cardiovascular disease, osteoporosis, and sarcopenia.
- Current screening strategies may not fully utilize opportunistic data from CT scans.
- Artificial intelligence (AI) offers potential for automated analysis of body composition from CT images.
Purpose of the Study:
- To evaluate the cost-effectiveness and clinical efficacy of AI-assisted opportunistic screening.
- To assess AI algorithms for body composition analysis (atherosclerotic cardiovascular disease, osteoporosis, sarcopenia) on abdominal CT.
- To compare AI-assisted screening against usual care and universal treatment strategies.
Main Methods:
- Markov models and 10-year simulations on hypothetical cohorts of 10,000 U.S. adults.
- Incorporation of disease prevalence, transition probabilities, healthcare costs, and treatment effectiveness.
- Comparison of three screening models: usual care, universal statin therapy, and AI-assisted opportunistic CT screening.
Main Results:
- AI-assisted opportunistic CT screening was cost-saving and more effective than "treat none" or "treat all" strategies.
- This strategy remained dominant across a wide range of input assumptions.
- Cost savings and clinical improvements were observed even with AI tool costs up to $227/patient (men) and $65/patient (women).
Conclusions:
- AI-assisted CT-based opportunistic screening is a highly cost-effective and clinically efficacious strategy.
- This approach demonstrates significant value across diverse scenarios and input assumptions.
- The findings support the integration of AI for opportunistic screening in routine abdominal CT examinations.
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.
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