Cost-effectiveness of radiologist reading of chest CT scans assisted by software with artificial intelligence–derived algorithms for the detection and analysis of lung nodules

Objective: To assess the cost-effectiveness of using artificial intelligence (AI)–derived software to assist reading CT scans of the chest to identify and analyse lung nodules compared to unaided reading in symptomatic, incidental and screening populations. Methods: Decision tree structures were developed in TreeAge Pro 2021. Structures were informed by British Thoracic Society clinical guidelines and clinical opinion. Results were presented as incremental cost-effectiveness ratios (ICERs) expressed as cost per quality-adjusted life-year (QALY) over a lifetime from the UK National Health Service and Personal Social Services perspective. Results: For the symptomatic population, the unaided radiologist reading strategy dominated the AI-assisted reading strategy. In the incidental population, unaided radiologist reading was cost-effective with an ICER of approximately £1000 per QALY. Conversely, in the screening population, AI-assisted radiologist reading dominated unaided reading. The cause of AI assistance being cost-effective depended on the number of people who had undergone CT surveillance because of non-cancerous findings. Given the limitations in the quality and quantity of evidence to inform inputs, these results should be interpreted with caution. Conclusion: Current analyses based on limited evidence suggested that, in the symptomatic and incidental populations, unaided radiologist reading may be the more cost-effective strategy, while in the screening population, AI-assisted radiologist reading appeared to be the dominant strategy. Better quality evidence is required to have a definitive answer about their cost-effectiveness. Advances in knowledge: This paper shows whether adding AI-derived software to radiologists' reading of CT scans to identify lung nodules offers good value for money.