Pricing and cost-saving potential for deep-learning computer-aided lung nodule detection software in CT lung cancer screening

ObjectiveAn increasing number of commercial deep learning computer-aided detection (DL-CAD) systems are available but their cost-saving potential is largely unknown. This study aimed to gain insight into appropriate pricing for DL-CAD in different reading modes to be cost-saving and to determine the potentially most cost-effective reading mode for lung cancer screening.MethodsIn three representative settings, DL-CAD was evaluated as a concurrent, pre-screening, and second reader. Scoping review was performed to estimate radiologist reading time with and without DL-CAD. Hourly cost of radiologist time was collected for the USA (euro196), UK (euro127), and Poland (euro45), and monetary equivalence of saved time was calculated. The minimum number of screening CTs to reach break-even was calculated for one-time investment of euro51,616 for DL-CAD.ResultsMean reading time was 162 (95% CI: 111-212) seconds per case without DL-CAD, which decreased by 77 (95% CI: 47-107) and 104 (95% CI: 71-136) seconds for DL-CAD as concurrent and pre-screening reader, respectively, and increased by 33-41 s for DL-CAD as second reader. This translates into euro1.0-4.3 per-case cost for concurrent reading and euro0.8-5.7 for pre-screening reading in the USA, UK, and Poland. To achieve break-even with a one-time investment, the minimum number of CT scans was 12,300-53,600 for concurrent reader, and 9400-65,000 for pre-screening reader in the three countries.ConclusionsGiven current pricing, DL-CAD must be priced substantially below euro6 in a pay-per-case setting or used in a high-workload environment to reach break-even in lung cancer screening. DL-CAD as pre-screening reader shows the largest potential to be cost-saving.Critical relevance statementDeep-learning computer-aided lung nodule detection (DL-CAD) software must be priced substantially below 6 euro in a pay-per-case setting or must be used in high-workload environments with one-time investment in order to achieve break-even. DL-CAD as a pre-screening reader has the greatest cost savings potential.Key points center dot DL-CAD must be substantially below euro6 in a pay-per-case setting to reach break-even.center dot DL-CAD must be used in a high-workload screening environment to achieve break-even.center dot DL-CAD as a pre-screening reader shows the largest potential to be cost-saving.Key points center dot DL-CAD must be substantially below euro6 in a pay-per-case setting to reach break-even.center dot DL-CAD must be used in a high-workload screening environment to achieve break-even.center dot DL-CAD as a pre-screening reader shows the largest potential to be cost-saving.Key points center dot DL-CAD must be substantially below euro6 in a pay-per-case setting to reach break-even.center dot DL-CAD must be used in a high-workload screening environment to achieve break-even.center dot DL-CAD as a pre-screening reader shows the largest potential to be cost-saving.

Automated summary

This study aimed to determine appropriate pricing for DL-CAD to be cost-saving and to identify the potentially most cost-effective reading mode for lung cancer screening. The results showed that DL-CAD as a pre-screening reader had the largest potential for cost savings.