COST-EFFECTIVENESS OF AI-ENHANCED OPPORTUNISTIC OSTEOPOROSIS SCREENING USING CHEST RADIOGRAPHS: EVIDENCE FROM SIX INTERNATIONAL ANALYSES

M. Hiligsmann1, M. Alokail2, J.-Y. Reginster 2

1Maastricht University, Maastricht, Netherlands, 2King Saud University, Riyadh, Saudi Arabia

Introduction: AI-enhanced analysis of routinely acquired chest radiographs enables

opportunistic osteoporosis screening without additional imaging. While individual studies

suggest economic value, evidence comparing results across healthcare systems is limited.

This study summarizes findings from six international cost-effectiveness analyses of AI-

enhanced opportunistic osteoporosis screening.

Methods: We reviewed six country-specific studies, four published and two recently

submitted, comparing AI-enhanced chest radiograph screening with no screening. Models

used local data on fracture incidence, costs, follow-up pathways, and treatment patterns.

Outcomes included costs, quality-adjusted life years (QALYs), incremental cost-effectiveness

ratios (ICERs), and key drivers.

Results: AI-enhanced screening was cost-effective in all six settings (Germany, United

States, Japan, Korea, Singapore, Australia). ICERs ranged from dominance (cost-saving with

QALY gains) to US$72,085 per QALY gained. Dominance occurred in some settings, largely

where fracture incidence or fracture-related costs were higher. Lifetime fractures prevented

per 10,000 screened people ranged from 16 (Singapore) to 44 (Germany). One evaluation

(Korea) included both sexes and showed cost-effectiveness in men and women. Across

countries, results were most sensitive to fracture costs, medication prices, adherence, and

follow-up after osteoporosis is suspected.

Discussion: Across diverse healthcare systems, AI-enhanced opportunistic screening

consistently produced favorable economic outcomes, though the size of benefit varied.

Differences in epidemiology, treatment patterns, and cost structures limit direct

generalizability, highlighting the need for local analyses. Overall, these findings support AI-

enhanced opportunistic screening as a scalable and efficient strategy to reduce the global

burden of osteoporotic fractures.

Acknowledgement: Funded by an unrestricted educational grant from Promedius, Inc.