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Signify Premium Insight: Accounting for Improved AI

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BMJ Open recently published a study which highlights the “cost effectiveness” of Perspectum’s LiverMultiScan software.

The study, a prepared study as opposed to real-world-evidence, assessed whether the use of Perspectum’s software, which in some cases, offers an alternative to liver biopsy, would offer cost savings to providers. The study found that by using LiverMultiScan to assess and monitor the condition of patients with autoimmune hepatitis (AIH) significant savings could be made. The use of the tool could, for example, lead to savings of almost £340,000 for 100 patients with moderate-to-severe AIH, while savings of more than £200,000 were demonstrated for 100 patients with mild-to-moderate AIH.

Such results are significant, but will they be enough to convince providers to adopt medical imaging AI?

The Signify View

In Signify Research’s AI in Medical Imaging – World Market Analysis 2022 the main barriers stymieing the adoption of medical imaging AI were identified and assessed. One of the barriers that was identified as being most impactful was AI’s “lack of real-world evidence demonstrating the health economic benefits, including return on investment, for providers”.

The significance of this barrier is easy to understand. While providers are often keen to have the latest technology, and claims of clinical performance, even when validated by studies, can be compelling, hospitals will be reluctant to commit to any investments that don’t offer a clear or immediate return on investment. As highlighted in a recent Premium Insight, some vendors are attempting to secure reimbursement in order to be able to highlight immediate return on investment. However, there are some drawbacks that mean such plans are no silver bullet.

Reimbursement, which for medical imaging AI solutions is itself unusual, has so far been primarily offered in the US. Given the localised uptake of AI solutions, which tend to gain more traction in their local markets, this could present a problem for any vendors hailing from outside the US. A further limitation is that reimbursement is not permanent and can be revised, or withdrawn at any point, a particular concern for codes that are introduced on a temporary basis. Such temporality is highlighted for reimbursement for HeartFlow’s FFR-CT tool, which has been revised down from around $1,500 to $930-$950. As such, the amount that providers must pay out of pocket has increased significantly.

Balancing the Books

By producing health economic studies, as, Perspectum has done, many of these challenges can be sidestepped. Providers will need to fund the initial purchase of a purchase, but they can do so knowing that, if they choose the right tool, the longer-term cost savings can be substantial.

Among the reasons for this value is the impact the tool’s use can have on the clinical pathway. Like other successful AI tools from the likes of HeartFlow and Viz.ai, Perspectum’s solution adjusts a patient’s care journey. Instead of patients being forced to undergo liver biopsies, which are not only expensive but invasive procedures that add risks and can impact a patient’s health, those suffering with hepatitis can have their liver health assessed using LiverMultiScan. An AI analysis is in many cases clinically preferable, while the results of Perspectum’s study show that it can also save them money. Use of the tool will, for some providers, become an increasingly obvious choice.

There are limitations to the study, however. It is a prepared clinical study, rather than real world observation or monitoring. As such, the study will not account for the broader spectrum of ways liver biopsy of autoimmune hepatitis patients is managed, with treatment plans and clinician preference varying significantly. There will also be discrepancies depending how frequently biopsies are undertaken, with those providers that undertake fewer biopsies seeing less substantial savings than those undertaking biopsies more frequently.

Invasive Alternative

Such caveats however are of limited importance. A hospital’s particular practices may grant them lesser or greater cost savings compared to those seen in the study, but the overall value of using the solution is evident. Biopsy will remain the gold standard, but both providers, and regulatory bodies will increasingly see other non-invasive solutions as viable alternatives to biopsy and other invasive diagnostic procedures under some studies.

Over time, this will also begin to shape products and influence development directions in the market. Perspectum’s study highlights the cost saving potential offered by LiverMultiScan, by replacing liver biopsies with an imaging AI assessment. This highlights opportunities for vendors in other areas where biopsies are common. Vendors working to develop similar solutions for prostate cancer imaging, for example, should be buoyed by Perspectum’s findings, but should also utilise it as a prompt to conduct its own comparable study.

More broadly, studies such as that conducted by Perspectum, will over time, offer a benchmark for other vendors, and give providers an idea and expectation of what cost savings are possible. Providers, in partnership with the AI vendors that are attempting to sell to them, will be able to utilise such studies, with data about their own hospitals, to calculate expected savings. The net effect should offer far better visibility over predicted spending and allowing providers to budget better over time. What’s more, as such health economic studies become more common, and providers start to expect health economic studies from vendors before they commit to a solution, AI developers will increasingly focus on adding value to their solutions, ensuring they have a compelling answer to this question. Moreover, such collaboration could pave the way towards “risk-sharing” business models proliferating.

Compelled by Cost

While Perspectum is far from the best funded medical imaging AI vendor, with a figure of $71m to date, it has made more headway than many other AI vendors. Alongside being able to demonstrate its cost effectiveness, which will be particularly valuable in many European countries and other single-payor markets, use of its LiverMultiScan product was also granted a CPT code in March 2022, allowing it to qualify for reimbursement. This means that in the US, providers can be paid to utilise a tool that helps them save money, making it a very compelling option.

Such progress means the vendor must now question, what next? While it might be tempting to expand out into other lucrative areas, the vendor would be better served by doubling down on its focus on the liver. While the BMJ Open study focuses on hepatitis, Perspectum now stands in good stead to develop similar results for other liver conditions, such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). What’s more, as growing pathologies, pharmaceutical companies are working hard to bring treatments for NAFLD, NASH and other liver conditions to market. As these pharmaceutical interventions become more widely available, providers will be much more incentivised to adopt tools that can help them identify such conditions. If Perspectum can establish itself as the market leader in the non-invasive AI liver specialist, it is well placed to ride this rising tide and capitalise on the market’s growth.

In most instances, as medical imaging AI has evolved through its nascency, many solutions have relied on their ability to replicate or supplement the work of a radiologists. A smaller number of solutions looked to bring greater value to hospitals, focusing on the clinical value they could offer providers. These have gained traction and renown through their ability to improve outcomes for patients. While Perspectum also holds this as a focus, it has demonstrated another step forward for medical imaging AI; proving a solution’s monetary worth. This, for many providers, will be the metric that tips them toward AI adoption, with AI now justifiable as well as desirable.

About Signify Premium Insights

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify ResearchTo view other recent Premium Insights that are part of the service please click here