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Huang XM, Yang BF, Zheng WL, Liu Q, Xiao F, Ouyang PW, Li MJ, Li XY, Meng J, Zhang TT, Cui YH, Pan HW. Cost-effectiveness of artificial intelligence screening for diabetic retinopathy in rural China. BMC Health Serv Res 2022; 22:260. [PMID: 35216586 PMCID: PMC8881835 DOI: 10.1186/s12913-022-07655-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) has become a leading cause of global blindness as a microvascular complication of diabetes. Regular screening of diabetic retinopathy is strongly recommended for people with diabetes so that timely treatment can be provided to reduce the incidence of visual impairment. However, DR screening is not well carried out due to lack of eye care facilities, especially in the rural areas of China. Artificial intelligence (AI) based DR screening has emerged as a novel strategy and show promising diagnostic performance in sensitivity and specificity, relieving the pressure of the shortage of facilities and ophthalmologists because of its quick and accurate diagnosis. In this study, we estimated the cost-effectiveness of AI screening for DR in rural China based on Markov model, providing evidence for extending use of AI screening for DR. METHODS We estimated the cost-effectiveness of AI screening and compared it with ophthalmologist screening in which fundus images are evaluated by ophthalmologists. We developed a Markov model-based hybrid decision tree to analyze the costs, effectiveness and incremental cost-effectiveness ratio (ICER) of AI screening strategies relative to no screening strategies and ophthalmologist screening strategies (dominated) over 35 years (mean life expectancy of diabetes patients in rural China). The analysis was conducted from the health system perspective (included direct medical costs) and societal perspective (included medical and nonmedical costs). Effectiveness was analyzed with quality-adjusted life years (QALYs). The robustness of results was estimated by performing one-way sensitivity analysis and probabilistic analysis. RESULTS From the health system perspective, AI screening and ophthalmologist screening had incremental costs of $180.19 and $215.05 but more quality-adjusted life years (QALYs) compared with no screening. AI screening had an ICER of $1,107.63. From the societal perspective which considers all direct and indirect costs, AI screening had an ICER of $10,347.12 compared with no screening, below the cost-effective threshold (1-3 times per capita GDP of Chinese in 2019). CONCLUSIONS Our analysis demonstrates that AI-based screening is more cost-effective compared with conventional ophthalmologist screening and holds great promise to be an alternative approach for DR screening in the rural area of China.
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Affiliation(s)
- Xiao-Mei Huang
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Bo-Fan Yang
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Wen-Lin Zheng
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China.,Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Qun Liu
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Fan Xiao
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China.,Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Pei-Wen Ouyang
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Mei-Jun Li
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Xiu-Yun Li
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Jing Meng
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | | | - Yu-Hong Cui
- School of Basic Medical Sciences, The Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Histology and Embryology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Hong-Wei Pan
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China. .,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China.
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Hong L, Cheng X, Zheng D. Application of Artificial Intelligence in Emergency Nursing of Patients with Chronic Obstructive Pulmonary Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6423398. [PMID: 34908913 PMCID: PMC8635944 DOI: 10.1155/2021/6423398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
The research achievements of artificial intelligence technology in the development of chronic obstructive pulmonary disease were explored, and the advantages and problems encountered in the development of intelligent nursing were analyzed. This paper presents the application of artificial intelligence in the emergency care of patients with chronic obstructive pulmonary disease. The method included 447 COPD patients in a randomized controlled trial to observe the improvement of quality of life at 4 and 12 months after artificial intelligence medical intervention. A prospective randomized controlled trial included 101 patients with COPD who underwent a 9-month web-based knowledge exercise on the prevention of acute exacerbation of COPD through artificial intelligence medicine and were randomly divided into two groups: the experimental group and the control group. The results show that, in the experimental group and the control group, after 4 months, the quality of life does not change; after 12 months, compared with controls, the quality of life and emotional and psychological conditions have improved obviously. 29 patients who participated in the experiment and were randomly divided into the experimental group and the control group showed satisfactory results. COPD hospitalized rate and length of hospital stay were decreased in the experimental group than in the control group. For single-factor analysis, artificial intelligence medical intervention has not achieved significant significance, and the experimental results have preliminarily confirmed the effectiveness of artificial intelligence medical treatment.
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Affiliation(s)
- Lingzhi Hong
- Department of Emergency, The First People's Hospital of Chun'an County, Hangzhou, Zhejiang 311700, China
| | - Xufang Cheng
- Department of Nursing, The First People's Hospital of Chun'an County, Hangzhou, Zhejiang 311700, China
| | - Deming Zheng
- Department of Infection, The First People's Hospital of Chun'an County, Hangzhou, Zhejiang 311700, China
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