{"id":"AIBD-0746","title":"Québec's assessment agency INESSS finds that AI grading of diabetic eye photos appears cost-efficient, at the price of lower specificity","summary":"INESSS reviewed two economic studies from the UK and Singapore. It found that AI grading of retinal photos seems efficient because its cost savings would offset its lower specificity.","date_observed":"2021-02-01","date_basis":"source publication","date_precision":"month","benefit_status":"mixed","source_collection":null,"source_entry":null,"account":"The Institut national d'excellence en santé et en services sociaux (INESSS) reviewed AI for diabetic retinopathy screening for Québec's health ministry in February 2021. It found that the systems can pick out patients who need treatment by a specialist. It also found that newer systems perform about as well as human readers or below them, and that specificity varies more in real-world data. Two economic studies compared tele-screening with and without AI, in the UK and Singapore. INESSS judged that AI grading with EyeArt, Retmarker or SELENA+ seems efficient, because its cost savings would offset its lower specificity. In the UK study, replacing the first level of human grading saved £11.81 per correct result with Retmarker and £4.5 with EyeArt. The Singapore study projected avoided costs of 489 000 $, nearly 20% of the screening budget. In both studies, AI grading was cheaper and less effective than manual grading. INESSS cautions that the results may not transfer to Québec, which lacks an established screening program. It describes the versions in the UK study as expert systems and SELENA+ as a deep learning system.","category":"aggregate result","unexpected":false,"purpose":"Eyenuk, Retmarker and EyRIS built EyeArt, Retmarker and SELENA+ to grade retinal photographs for diabetic retinopathy and flag patients who need a specialist.","system":"AI diabetic retinopathy screening systems (IARD) in the two economic studies, EyeArt and Retmarker in the UK and SELENA+ in Singapore","model_version":"EyeArt 1.0 and Retmarker 0.8.2 in the UK study","developer":"Eyenuk (EyeArt), Retmarker Ltd (Retmarker) and EyRIS (SELENA+)","deployer":"Diabetic retinopathy screening programs in the United Kingdom and Singapore, as modeled in the studies that INESSS reviewed","location":"United Kingdom and Singapore (studies), with guidance for Québec, Canada","domain":"Healthcare","segment":null,"benefit_type":"Improved Organizational Efficiency","work_activities":["4.A.1.b.1"],"taxonomy_note":null,"registry_ids":{},"ratings":[{"group":"organizational","depth":null,"reason":"The savings come from economic models of other countries' programs, and INESSS judged that they may not transfer to Québec."}],"ai_role":{"status":"assessed","statement":"The two economic studies compared screening with and without AI grading, which isolates the AI's part within a model. INESSS describes the EyeArt 1.0 and Retmarker 0.8.2 versions in the UK study as expert systems and SELENA+ as a deep learning system. Only the Singapore result rests on a system shown to learn from data."},"evidence":[{"kind":"assessment report","citation":"Institut national d'excellence en santé et en services sociaux (INESSS). Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle. État des connaissances. Québec, February 2021. Résumé, Efficience.","title":"Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","date":null,"written_by":"independent","quote":"Deux études repérées évaluent l’IARD en comparaison avec le télédépistage sans l’IA (Royaume-Uni et Singapour). L’IARD (EyeArt, Retmarker, SELENA+) semble une technologie efficiente, puisque la réduction des coûts qu’elle engendre compenserait la diminution de l’efficacité (spécificité)."},{"kind":"assessment report","citation":"Institut national d'excellence en santé et en services sociaux (INESSS). Artificial intelligence-assisted diabetic retinopathy tele-screening, English summary, Efficiency. Québec, February 2021.","title":"Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle (English summary)","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","date":null,"written_by":"independent","quote":"Two identified studies evaluate AIDR in comparison to tele-screening without AI (UK and Singapore). AIDR (EyeArt, Retmarker, SELENA+) seems to be an efficient technology since the cost reduction it generates would compensate for the decrease in efficacy (specificity)."}],"replication":{"produced_by":["AI replaced the first level of human reading in the modeled screening programs.","Human graders read the images after the AI in the semi-automated model."],"must_hold":["The screening program is already well established, with care pathways that see referred patients on time.","Sensitivity and specificity in local use match those reported in the studies."],"echoes":[]},"paired_incident":null,"headline":"INESSS finds *AI retinopathy screening* cheaper per correct result","metric":"£11.81 per correct result with Retmarker","comparator":{"against":"Diabetic retinopathy tele-screening with human graders only","before":null,"after":"Lower cost and lower specificity with AI grading","basis":"assumed","quote":"Two identified studies evaluate AIDR in comparison to tele-screening without AI (UK and Singapore). AIDR (EyeArt, Retmarker, SELENA+) seems to be an efficient technology since the cost reduction it generates would compensate for the decrease in efficacy (specificity).","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf"},"later":null,"value":{"amount":"489 000 $","what":"Projected costs avoided when semi-automated AI screening replaces manual grading","who":"Singapore's health system","estimate":true,"quote":"Les coûts évités projetés pour le système de santé de Singapour avec le dépistage semi-autonome en remplacement du dépistage manuel sont évalués à 489 000 $, soit près de 20 % du budget total du dépistage.","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf"},"developer_country":"Multiple: United States, Portugal, Singapore","deployer_country":"Multiple: United Kingdom, Singapore","unrated_because":"The savings are projections from economic models, and INESSS judged that they cannot be fully transposed to Québec.","brief_notes":null,"brief":null,"revisions":[{"date":"2026-10-31","change":"Added the record from the finding of INESSS.","source":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","editor":"AIBD"}],"confidence":"found","shade":"high","claim_status":"Found by an assessment body","claim_basis":"Sources: one independent assessment report. The cited evidence includes no independent study or report.","case_jurisdictions":["United Kingdom","Singapore","Canada"],"profile":{"case_id":"AIBD-0746","catalog_version":"1.0.0","source_fingerprint":"75f43a94460988faca1585e2bb01ba66e6b1e14bdb1942fa8fbf5903c6b7a6f8","collection_refs":[{"collection_id":"aibd","version":"2026-10-31"},{"collection_id":"querist","version":"2026-10-25"}],"source_ids":["AIBD-0746-source-0001","AIBD-0746-source-0002"],"families":{"strategic assessments":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"Editorial assignment.","review_state":"not_assessed","coverage":"partial","record_ids":[]},"evaluations":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"Editorial assignment.","review_state":"not_assessed","coverage":"partial","record_ids":[]},"monetary observations":{"state":"value_present","value":{"kind":"text","text":"An existing source-stated monetary observation is present in the original value object."},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["value"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial","record_ids":["AIBD-0746-legacy-value"]},"institutional decisions":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"Editorial assignment.","review_state":"not_assessed","coverage":"partial","record_ids":[]}},"fields":{"actors[]":{"state":"value_present","value":{"kind":"record_fields","fields":{"developer":"Eyenuk (EyeArt), Retmarker Ltd (Retmarker) and EyRIS (SELENA+)","deployer":"Diabetic retinopathy screening programs in the United Kingdom and Singapore, as modeled in the studies that INESSS reviewed"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["developer","deployer"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"actors[].ownership_control":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"ai_contribution":{"state":"value_present","value":{"kind":"record_fields","fields":{"ai_role":{"status":"assessed","statement":"The two economic studies compared screening with and without AI grading, which isolates the AI's part within a model. INESSS describes the EyeArt 1.0 and Retmarker 0.8.2 versions in the UK study as expert systems and SELENA+ as a deep learning system. Only the Singapore result rests on a system shown to learn from data."}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["ai_role"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"ai_relationship":{"state":"value_present","value":{"kind":"record_fields","fields":{"category":"aggregate result","ai_role":{"status":"assessed","statement":"The two economic studies compared screening with and without AI grading, which isolates the AI's part within a model. INESSS describes the EyeArt 1.0 and Retmarker 0.8.2 versions in the UK study as expert systems and SELENA+ as a deep learning system. Only the Singapore result rests on a system shown to learn from data."}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["ai_role","category"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"assessments[].alternatives":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"assessments[].assessor_date":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"assessments[].depth":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"assessments[].display_confidence":{"state":"value_present","value":{"kind":"structured","data":{"confidence":"high","evidence_word":"found","claim_status":"Found by an assessment body","basis":"Sources: one independent assessment report. The cited evidence includes no independent study or report.","interpretation":"Existing display rule preserved; the richer outcome-specific confidence question still needs review."}},"provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"assessments[].rationale":{"state":"value_present","value":{"kind":"record_fields","fields":{"ratings":[{"group":"organizational","reason":"The savings come from economic models of other countries' programs, and INESSS judged that they may not transfer to Québec."}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["ratings"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"assessments[].rubric_version":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"assessments[].status_basis":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"assessments[].target":{"state":"value_present","value":{"kind":"record_fields","fields":{"ratings":[{"group":"organizational","reason":"The savings come from economic models of other countries' programs, and INESSS judged that they may not transfer to Québec."}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["ratings"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"availability":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"brief":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"case_kind":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"case_links[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"claims[].evidence_links":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"claims[].evidence_strength":{"state":"value_present","value":{"kind":"structured","data":{"answer":"Found by an assessment body. Sources: one independent assessment report. The cited evidence includes no independent study or report.","evidence_word":"found","claim_status":"Found by an assessment body"}},"provenance":{"kind":"source_review","basis":"Editorial assignment.","record_fields":["evidence"],"source_refs":["AIBD-0746-source-0001","AIBD-0746-source-0002"],"reviewed_on":"2026-10-29"},"review_state":"reviewed","coverage":"complete","display":{"answer":"Found by an assessment body. Sources: one independent assessment report. The cited evidence includes no independent study or report.","inferred":false}},"claims[].missingness":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"claims[].proposition":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"cross_border_flows[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"decisions[].action_outcome":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"institutional decisions"},"decisions[].grounds":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"institutional decisions"},"decisions[].institution_task":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"institutional decisions"},"decisions[].success_criterion":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"institutional decisions"},"deployment_stage":{"state":"value_present","value":{"kind":"structured","data":{"classification":"simulated","answer":"The benefit was shown in a simulation. The cost savings come from economic models of screening programs in the United Kingdom and Singapore.","scope":"The period and activity described in the case."}},"provenance":{"kind":"source_review","basis":"Editorial assignment.","record_fields":["account","evidence"],"source_refs":["AIBD-0746-source-0001"],"reviewed_on":"2026-10-29"},"review_state":"reviewed","coverage":"complete","display":{"answer":"The benefit was shown in a simulation. The cost savings come from economic models of screening programs in the United Kingdom and Singapore.","inferred":false}},"economics[].amount":{"state":"value_present","value":{"kind":"record_fields","fields":{"value":{"amount":"489 000 $","what":"Projected costs avoided when semi-automated AI screening replaces manual grading","who":"Singapore's health system","estimate":true,"quote":"Les coûts évités projetés pour le système de santé de Singapour avec le dépistage semi-autonome en remplacement du dépistage manuel sont évalués à 489 000 $, soit près de 20 % du budget total du dépistage.","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf"}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["value"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"economics[].costs[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].counterfactual":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].currency_price_basis":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].gross_net":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].measure_type":{"state":"value_present","value":{"kind":"record_fields","fields":{"value":{"amount":"489 000 $","what":"Projected costs avoided when semi-automated AI screening replaces manual grading","who":"Singapore's health system","estimate":true,"quote":"Les coûts évités projetés pour le système de santé de Singapour avec le dépistage semi-autonome en remplacement du dépistage manuel sont évalués à 489 000 $, soit près de 20 % du budget total du dépistage.","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf"}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["value"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"economics[].period_unit":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].realization":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].recipient_payer":{"state":"value_present","value":{"kind":"record_fields","fields":{"value":{"amount":"489 000 $","what":"Projected costs avoided when semi-automated AI screening replaces manual grading","who":"Singapore's health system","estimate":true,"quote":"Les coûts évités projetés pour le système de santé de Singapour avec le dépistage semi-autonome en remplacement du dépistage manuel sont évalués à 489 000 $, soit près de 20 % du budget total du dépistage.","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf"}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["value"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"economics[].return_payback":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"economics[].valuation_method":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"evaluations[].ai_uplift":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].comparator":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].design":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].effect":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].exposure":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].id":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].measurement_method":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].metric":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].reproduction_materials":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].setting_sample":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"evaluations[].uncertainty_limitations":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"evaluations"},"external_references[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"follow_up[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"human_oversight":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"id":{"state":"value_present","value":{"kind":"record_fields","fields":{"id":"AIBD-0746"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["id"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"infrastructure_dependencies[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].beneficiaries":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].beneficiary_count":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].benefit_type":{"state":"value_present","value":{"kind":"record_fields","fields":{"benefit_type":"Improved Organizational Efficiency"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["benefit_type"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"outcomes[].claim":{"state":"value_present","value":{"kind":"record_fields","fields":{"account":"The Institut national d'excellence en santé et en services sociaux (INESSS) reviewed AI for diabetic retinopathy screening for Québec's health ministry in February 2021. It found that the systems can pick out patients who need treatment by a specialist. It also found that newer systems perform about as well as human readers or below them, and that specificity varies more in real-world data. Two economic studies compared tele-screening with and without AI, in the UK and Singapore. INESSS judged that AI grading with EyeArt, Retmarker or SELENA+ seems efficient, because its cost savings would offset its lower specificity. In the UK study, replacing the first level of human grading saved £11.81 per correct result with Retmarker and £4.5 with EyeArt. The Singapore study projected avoided costs of 489 000 $, nearly 20% of the screening budget. In both studies, AI grading was cheaper and less effective than manual grading. INESSS cautions that the results may not transfer to Québec, which lacks an established screening program. It describes the versions in the UK study as expert systems and SELENA+ as a deep learning system.","benefit_type":"Improved Organizational Efficiency"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["account","benefit_type"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"outcomes[].distribution":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].duration":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].id":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].stakeholder_group":{"state":"value_present","value":{"kind":"record_fields","fields":{"ratings":[{"group":"organizational","reason":"The savings come from economic models of other countries' programs, and INESSS judged that they may not transfer to Québec."}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["ratings"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"outcomes[].status":{"state":"value_present","value":{"kind":"record_fields","fields":{"benefit_status":"mixed"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["benefit_status"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"outcomes[].tradeoffs":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"outcomes[].unexpected":{"state":"value_present","value":{"kind":"record_fields","fields":{"unexpected":false,"purpose":"Eyenuk, Retmarker and EyRIS built EyeArt, Retmarker and SELENA+ to grade retinal photographs for diabetic retinopathy and flag patients who need a specialist."}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["unexpected","purpose"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"places[]":{"state":"value_present","value":{"kind":"record_fields","fields":{"location":"United Kingdom and Singapore (studies), with guidance for Québec, Canada","developer_country":"Multiple: United States, Portugal, Singapore","deployer_country":"Multiple: United Kingdom, Singapore"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["location","developer_country","deployer_country"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"purpose":{"state":"value_present","value":{"kind":"record_fields","fields":{"purpose":"Eyenuk, Retmarker and EyRIS built EyeArt, Retmarker and SELENA+ to grade retinal photographs for diabetic retinopathy and flag patients who need a specialist."}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["purpose"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"record_dates":{"state":"value_present","value":{"kind":"record_fields","fields":{"date_observed":"2021-02-01","date_basis":"source publication","date_precision":"month","revisions":[{"date":"2026-10-31","change":"Added the record from the finding of INESSS.","source":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","editor":"AIBD"}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["date_observed","date_basis","date_precision","revisions"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"replication.attempts[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"replication.conditions":{"state":"value_present","value":{"kind":"record_fields","fields":{"replication":{"produced_by":["AI replaced the first level of human reading in the modeled screening programs.","Human graders read the images after the AI in the semi-automated model."],"must_hold":["The screening program is already well established, with care pathways that see referred patients on time.","Sensitivity and specificity in local use match those reported in the studies."],"echoes":[]}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["replication"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"revision_history[]":{"state":"value_present","value":{"kind":"record_fields","fields":{"revisions":[{"date":"2026-10-31","change":"Added the record from the finding of INESSS.","source":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","editor":"AIBD"}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["revisions"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"sector":{"state":"value_present","value":{"kind":"record_fields","fields":{"domain":"Healthcare"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["domain"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"sources[].access_version":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"sources[].citation_locator":{"state":"value_present","value":{"kind":"record_fields","fields":{"evidence":[{"kind":"assessment report","citation":"Institut national d'excellence en santé et en services sociaux (INESSS). Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle. État des connaissances. Québec, February 2021. Résumé, Efficience.","title":"Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","written_by":"independent","quote":"Deux études repérées évaluent l’IARD en comparaison avec le télédépistage sans l’IA (Royaume-Uni et Singapour). L’IARD (EyeArt, Retmarker, SELENA+) semble une technologie efficiente, puisque la réduction des coûts qu’elle engendre compenserait la diminution de l’efficacité (spécificité)."},{"kind":"assessment report","citation":"Institut national d'excellence en santé et en services sociaux (INESSS). Artificial intelligence-assisted diabetic retinopathy tele-screening, English summary, Efficiency. Québec, February 2021.","title":"Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle (English summary)","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","written_by":"independent","quote":"Two identified studies evaluate AIDR in comparison to tele-screening without AI (UK and Singapore). AIDR (EyeArt, Retmarker, SELENA+) seems to be an efficient technology since the cost reduction it generates would compensate for the decrease in efficacy (specificity)."}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["evidence"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"sources[].id":{"state":"value_present","value":{"kind":"identifiers","identifiers":["AIBD-0746-source-0001","AIBD-0746-source-0002"],"role":"Existing evidence items, in their original order"},"provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"review_state":"record_mapped","coverage":"complete"},"sources[].language":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"sources[].relationship":{"state":"value_present","value":{"kind":"record_fields","fields":{"evidence":[{"kind":"assessment report","citation":"Institut national d'excellence en santé et en services sociaux (INESSS). Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle. État des connaissances. Québec, February 2021. Résumé, Efficience.","title":"Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","written_by":"independent","quote":"Deux études repérées évaluent l’IARD en comparaison avec le télédépistage sans l’IA (Royaume-Uni et Singapour). L’IARD (EyeArt, Retmarker, SELENA+) semble une technologie efficiente, puisque la réduction des coûts qu’elle engendre compenserait la diminution de l’efficacité (spécificité)."},{"kind":"assessment report","citation":"Institut national d'excellence en santé et en services sociaux (INESSS). Artificial intelligence-assisted diabetic retinopathy tele-screening, English summary, Efficiency. Québec, February 2021.","title":"Télédépistage de la rétinopathie diabétique à l'aide d'une solution d'intelligence artificielle (English summary)","url":"https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/INESSS_IA_TDRD_EC.pdf","written_by":"independent","quote":"Two identified studies evaluate AIDR in comparison to tele-screening without AI (UK and Singapore). AIDR (EyeArt, Retmarker, SELENA+) seems to be an efficient technology since the cost reduction it generates would compensate for the decrease in efficacy (specificity)."}]}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["evidence"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"sources[].upstream_sources":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"strategic_assessments[]":{"state":"unresolved","review_state":"not_assessed","coverage":"partial","family":"strategic assessments"},"summary":{"state":"value_present","value":{"kind":"record_fields","fields":{"summary":"INESSS reviewed two economic studies from the UK and Singapore. It found that AI grading of retinal photos seems efficient because its cost savings would offset its lower specificity.","account":"The Institut national d'excellence en santé et en services sociaux (INESSS) reviewed AI for diabetic retinopathy screening for Québec's health ministry in February 2021. It found that the systems can pick out patients who need treatment by a specialist. It also found that newer systems perform about as well as human readers or below them, and that specificity varies more in real-world data. Two economic studies compared tele-screening with and without AI, in the UK and Singapore. INESSS judged that AI grading with EyeArt, Retmarker or SELENA+ seems efficient, because its cost savings would offset its lower specificity. In the UK study, replacing the first level of human grading saved £11.81 per correct result with Retmarker and £4.5 with EyeArt. The Singapore study projected avoided costs of 489 000 $, nearly 20% of the screening budget. In both studies, AI grading was cheaper and less effective than manual grading. INESSS cautions that the results may not transfer to Québec, which lacks an established screening program. It describes the versions in the UK study as expert systems and SELENA+ as a deep learning system."}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["summary","account"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"systems[].autonomy_permissions":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].component_role":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].deployment_configuration":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].inputs_outputs":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].model_name":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"systems[].model_version":{"state":"value_present","value":{"kind":"record_fields","fields":{"model_version":"EyeArt 1.0 and Retmarker 0.8.2 in the UK study"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["model_version"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"systems[].product_name":{"state":"value_present","value":{"kind":"record_fields","fields":{"system":"AI diabetic retinopathy screening systems (IARD) in the two economic studies, EyeArt and Retmarker in the UK and SELENA+ in Singapore"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["system"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"systems[].provider":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"taxonomy_crosswalks[]":{"state":"unresolved","provenance":{"kind":"curatorial","basis":"Editorial assignment.","record_fields":[],"source_refs":[]},"reason":"This is an explicit unresolved assignment: the sources on record do not settle this question.","review_state":"not_assessed","coverage":"partial"},"title":{"state":"value_present","value":{"kind":"record_fields","fields":{"title":"Québec's assessment agency INESSS finds that AI grading of diabetic eye photos appears cost-efficient, at the price of lower specificity","headline":"INESSS finds *AI retinopathy screening* cheaper per correct result"}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["title","headline"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"},"version":{"state":"value_present","value":{"kind":"identifiers","identifiers":["ac7c36c3a61cbf559554e070cd2319aa39f2c35505c8553b9308e7d321c0351f"],"role":"SHA-256 of the complete public record and its assessments"},"provenance":{"kind":"curatorial","basis":"SHA-256 of the public record, its assessments, and its displayed answers and notes, excluding its own identifier and the derived coverage summary.","record_fields":[],"source_refs":[]},"review_state":"record_mapped","coverage":"complete"},"workflow":{"state":"value_present","value":{"kind":"record_fields","fields":{"account":"The Institut national d'excellence en santé et en services sociaux (INESSS) reviewed AI for diabetic retinopathy screening for Québec's health ministry in February 2021. It found that the systems can pick out patients who need treatment by a specialist. It also found that newer systems perform about as well as human readers or below them, and that specificity varies more in real-world data. Two economic studies compared tele-screening with and without AI, in the UK and Singapore. INESSS judged that AI grading with EyeArt, Retmarker or SELENA+ seems efficient, because its cost savings would offset its lower specificity. In the UK study, replacing the first level of human grading saved £11.81 per correct result with Retmarker and £4.5 with EyeArt. The Singapore study projected avoided costs of 489 000 $, nearly 20% of the screening budget. In both studies, AI grading was cheaper and less effective than manual grading. INESSS cautions that the results may not transfer to Québec, which lacks an established screening program. It describes the versions in the UK study as expert systems and SELENA+ as a deep learning system.","replication":{"produced_by":["AI replaced the first level of human reading in the modeled screening programs.","Human graders read the images after the AI in the semi-automated model."],"must_hold":["The screening program is already well established, with care pathways that see referred patients on time.","Sensitivity and specificity in local use match those reported in the studies."],"echoes":[]}}},"provenance":{"kind":"legacy_record","basis":"Editorial assignment.","record_fields":["account","replication"],"source_refs":[]},"review_state":"record_mapped","coverage":"partial"}},"summary":{"total":91,"addressed":91,"known":32,"reviewed":2,"reviewed_complete":2,"reviewed_partial":0,"record_mapped":30,"review_not_assessed":59,"not_assessed":0,"complete":false,"by_state":{"value_present":32,"not_reported":0,"unresolved":59,"not_assessed":0,"not_applicable":0,"withheld":0,"source_unavailable":0}}},"presentation_version":"cce1e983a780119e1894d2585402409d55f34fcb861c8c691e611e4ba3960eeb"}