Economic analysis of an AI-enabled ECG alert system: impact on mortality outcomes from a pragmatic randomized trial
Open accessAbstract
Findings from a previous study (ClinicalTrials.gov: NCT05118035) demonstrated that an AI-enabled electrocardiogram (AI-ECG), combining AI reports and physician alerts, effectively identified hospitalized patients at high risk of mortality and reduced all-cause mortality. This study evaluates its cost-effectiveness from the health payer's perspective in Taiwan over a 90-day post-intervention period. Cost data were obtained from electronic health records of participating hospitals, and incremental cost-effectiveness ratios (ICERs) per death averted were calculated. Non-parametric bootstrap techniques were used to address uncertainty. Among 15,965 patients, 90-day all-cause mortality was 3.6% in the intervention group versus 4.3% in controls. Medication and ICU costs were higher in the AI-ECG group, but overall medical cost was similar ($6204 vs. $5803). The ICER was $59,500 (95% CI: $-4657 to $385,950) per death averted. The cost-effectiveness acceptability curve showed that 95% of the probability mass lies below a willingness-to-pay threshold of $409,321, supporting favorable cost-effectiveness despite uncertainty.
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The economic value of AI-ECG will depend less on the marginal cost of running the algorithm than on whether it improves the targeting of confirmatory testing and patient outcomes.
“Its economic value will depend less on the marginal cost of running the algorithm than on whether it improves the targeting of confirmatory testing and patient outcomes [43].”
From Deep Learning Applied to 12-Lead ECGs for Detection of Structural, Metabolic and Systemic Disease (2026) · cites this paper as [43]
The Discussion says the algorithm’s cost had little effect on cost-effectiveness and focuses instead on the costs of subsequent interventions relative to reduced mortality. It mentions echocardiograms to confirm low ejection fraction in a previous trial, but does not show that the alert system studied here improved the targeting of confirmatory testing. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe Taiwanese ARISE economic analysis evaluated an inpatient AI-ECG mortality-alert strategy and reported an ICER of $59,500 per death averted; it should be regarded as adjacent evidence for AI-enabled cardiovascular alerting rather than direct corroboration of low-LVEF screening cost-effectiveness.
“By contrast, the Taiwanese ARISE economic analysis evaluated an inpatient AI-ECG mortality-alert strategy and reported an ICER of $59,500 per death averted; it should therefore be regarded as adjacent evidence for AI-enabled cardiovascular alerting rather than direct corroboration of low-LVEF screening cost-effectiveness.58”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [58]
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- Authors
- Hsieh, P.-H., Lin, C., Lin, C.-S., Liu, W.-T., Lin, T.-K., Tsai, D.-J., Hung, Y.-J., Chen, Y.-H., Lin, C.-Y., Lin, S.-H., & Tsai, C.-S.
- Affiliations
- National Defense Medical Center (TW)
- Tri-Service General Hospital (TW)
- Corresponding author
- Tsai, Chien-Sung
- ORCID
- Venue
- npj Digital Medicine
- Published
- 2025-06-11
- Volume
- 8
- Issue
- 1
- Pages
- 348-348
- ISSN
- 2398-6352 (ISSN-L)
- PMC
- PMC12152136
- OpenAlex
- W4411164605
- Cited by
- 11
- References
- 35
- Citations by year
- 2026: 9 · 2025: 2
- FWCI
- 10.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- npj Digital Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Science and Technology Council (NSTC 113-2320-B-016-011)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- mortality prediction, cost-effectiveness, incremental cost-effectiveness ratio, all-cause mortality, hospitalized patients, cost-effectiveness acceptability curves, Taiwan
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