Cost-Effectiveness of Opportunistic Osteoporosis Screening Using Chest Radiographs With Deep Learning in the United States.

Abstract

Objectives: Deep learning models applied to chest radiographs obtained for other clinical reasons have shown promise in opportunistic osteoporosis screening, particularly among middle-aged to older individuals. This study evaluates the cost-effectiveness of this approach in US women aged 50 years and over.

Methods: An economic model, incorporating both a decision tree and a microsimulation Markov model, estimated the cost per quality-adjusted life-year (QALY) gained (in 2024 US dollars) for screening via chest radiographs with deep learning, followed by treatment, versus no screening and treatment. The patient pathways were based on the sensitivity and specificity of artificial intelligence-enhanced radiographs. Real-world medication persistence, realistic assumptions for probabilities of dual-energy x-ray absorptiometry examination postscreening detection and for treatment initiation rates were incorporated. Women with osteoporosis were stratified into high risk (receiving alendronate monotherapy for 5 years) and very high risk (receiving an 18-month anabolic treatment with abaloparatide followed by 5 years of alendronate). Parameter uncertainty was analyzed through sensitivity analyses.

Results: The opportunistic screening strategy improved health outcomes, yielding more QALYs and fewer fractures while increasing treatment costs. The cost per QALY gained of opportunistic screening was estimated at $72,085 per QALY gained among women 50+, remaining below the US cost-effectiveness threshold of $100,000 per QALY. Further improvements in cost-effectiveness could be achieved by optimizing follow-up, treatment initiation, and medication adherence.

Discussion: This study underscores the cost-effectiveness and public health value of opportunistic, artificial intelligence-driven screening osteoporosis screening using existing chest radiographs, demonstrating its potential to improve early detection and address unmet diagnostic needs in osteoporosis care.