Colonoscopy screening with add-on AI could save $290 million a year

Using artificial intelligence (AI) during screening colonoscopy could be a cost-effective strategy that could also boost colorectal cancer (CRC) incidence and mortality prevention, one researcher reported.

Among a simulated cohort of patients at average risk for CRC, and compared with no screening, the relative reduction in CRC incidence was 44.2% with screening colonoscopy without AI tools and 48.9% with screening colonoscopy with AI tools, for an incremental gain of 4.8%. In addition, compared with no screening, the relative reduction in CRC mortality was 48.7% for screening colonoscopy without AI versus 52.3% for screening colonoscopy with AI, for a 3.6% incremental gain, reported Yuichi Mori, MD, from Showa University Yokohama Northern Hospital in Japan.

AI detection tools were also associated with cost savings of $57 per patient after reducing the reduced cost from $3,400 to $3,343, which persisted in secondary colonoscopy model analysis, Mori said in a presentation at Digestive Disease Week (DDW). The findings were published simultaneously in the Lancet Digital Health

“At the US population level, the implementation of AI sensing during screening colonoscopy resulted in an additional 7,194 annual prevention [CRC] cases and 2,089 related deaths, and annual savings of US$290 million,” Mori and colleagues wrote.

“We are able to find a cost reduction as a whole. That is very surprising because the primary use of AI increases costs, but it can be due to the preventive effect of colon cancer,” Mori said at a DDW press conference.

“Using AI for polyp detection increases costs primarily because it can increase the detection of polyps, adenomas and the number of polypectomies, and subsequently increase the number of surveillance colonoscopies,” explains Mori. “However, this kind of increase could be mitigated by the benefits of using AI, namely the cancer prevention effect with the increase in ADR [adenoma detection rates] by AI. So it’s quite important how the deployment of AI contributes to the healthcare system in terms of cost-effectiveness.”

The study had some limitations, including that the authors assumed “a linear relationship between the cancer prevention effect and increased ADR, [and] there is ongoing debate about whether there is a threshold effect of ADR in cancer prevention.” Also, the authors “assumed the same increase in the detection rate of high-risk adenomas as low-risk adenomas when using AI for polyp detection, although the detection rate of advanced adenomas was not shown in [a] previous meta-analysis.”

Mori and colleagues used Markov model microsimulation in a hypothetical cohort of 100,000 U.S. patients who underwent colonoscopy screening with or without AI every 10 years, starting at age 50 and ending at age 80. Patients had no personal or family history of CRC, adenomas, inflammatory bowel disease, or hereditary CRC syndrome.

“The costs of AI tools and the costs of downstream treatment of screening-detected diseases were estimated at 3% annual discount rates,” they stated.

The authors reported that, based on a 60% screening uptake assumption, screening colonoscopy reduced the incidence of CRC from 6.0% cases per 100,000 to 3.3% cases per 100,000, which corresponded to an absolute reduction of 2,638 cases per 100,000 and a relative reduction of 44.2% versus no screening. Compared to colonoscopy without AI, the implementation of AI further reduced the incidence of CRC from 3.3% to 3.0% cases per 100,000 people, and the CRC mortality from 1.2% to 1.1% per 100,000 people, they said.

“This corresponds to an additional 0.3% absolute reduction (8.4% relative reduction) in [CRC] incidence and 0.1% absolute reduction (6.9% relative reduction) of [CRC] mortality, compared to colonoscopy without AI,” the authors said.

Mori’s group also found that AI further reduced costs related to the treatment of CRC by 8.2%, from $1,636 to $1,502 per person, although this was “partially offset by the cost of AI implementation increasing the screening costs of $1,764 to $1,841 per person (also including surveillance colonoscopies and treatment for adverse events).”

“I would say that using AI during screening colonoscopy could be cost-effective in the US,” Mori concluded.

Mori said his group has plans for a large randomized trial in Europe and Japan, with long-term monitoring of the incidence of CRC as the primary endpoint.

disclosures

The study was funded by the European Commission and the Japan Society of Promotion of Science.

Mori revealed relationships with Olympus and Cybernet System. Co-authors revealed multiple relationships with the industry.

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