Clinical and economic impact of deep learning-enhanced opportunistic osteoporosis screening using chest radiographs with and without the osteoporosis self-assessment tool for Asians (OSTA).

UNLABELLED: Opportunistic analysis of chest radiographs with deep learning detects osteoporosis cost-effectively in women aged ≥ 50 years in Singapore. Adding OSTA marginally improves efficiency, but DL "deep learning" screening alone already reduces fractures and increases quality-adjusted life-years (QALYs) at acceptable cost.

PURPOSE: Osteoporosis is underdiagnosed in older women due to limited access to dual-energy X-ray absorptiometry (DXA). Chest radiographs are commonly performed, and deep learning (DL) algorithms can opportunistically detect osteoporosis features. This study evaluated the clinical and economic impact of DL-enhanced opportunistic screening, alone or with the Osteoporosis Self-Assessment Tool for Asians (OSTA), in Singaporean women aged ≥ 50 years.

METHODS: A lifetime microsimulation-based Markov model from the healthcare system perspective compared three strategies: DL screening alone, DL screening combined with OSTA, and no screening. Model inputs included screening performance, DXA referral rates, treatment uptake and adherence, and local fracture incidence and cost data. The base case assumed 5 years of alendronate therapy for treated women. Outcomes included fractures prevented, quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs).

RESULTS: Compared with no screening, DL screening alone reduced fractures and increased QALYs, with an ICER of S$46,412 per QALY at 17% osteoporosis prevalence, below a willingness to pay threshold of S$85,000. Adding OSTA improved efficiency, decreasing the ICER by ~ 6% while slightly improving clinical benefits. Across a prevalence range of 9.3%-37%, ICERs ranged from S$71,162 to S$24,749. When scaled to 10,000 women, the combined strategy could prevent 17 fractures, yield 7 additional life-years, and generate 16 QALYs.

CONCLUSION: DL-enhanced chest radiographs offer a cost-effective approach for opportunistic osteoporosis screening in Singaporean women aged ≥ 50 years. Combining with OSTA slightly improves efficiency, but DL screening alone is already cost-effective and provides a scalable preventive strategy in real-world healthcare.