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2026 · Journal of Bone and Joint Surgery American Volume

What Is the Lifetime Cost-effectiveness of AI-assisted KL Grading in the Korean Healthcare System?

Estimated lifetime cost and QALYs were $137,710 and 22.721 for the AI strategy, versus $140,834 and 22.461 for conventional assessment. The paper reported a $3,125 cost reduction, a 0.260 QALY gain and an ICER of −$12,031/QALY.

Treatment pathways and lifetime progression model after AI grading

Original Figure 1: Treatment pathways and lifetime progression model after AI gradingEnlarge Figure

The decision tree for year one and the subsequent Markov model estimate costs and QALYs across KL grades, treatment states and death.

KyungYi Kim, Sang Yoon Kim, Sung Sik Kim, Jae Hun Kim, Du Hyun Ro, Byung Sun Choi. Cost-Effectiveness of AI-Assisted Kellgren-Lawrence Grading of Knee Osteoarthritis in the South Korean Health-Care System (2026). DOI: 10.2106/JBJS.25.01278 · Figure 1, Original, unchanged.

Evidence & Original SourceImage use terms

Model uncertainty: probabilistic sensitivity analysis

Original Figure 4: Model uncertainty: probabilistic sensitivity analysisEnlarge Figure

The horizontal axis shows incremental QALYs and the vertical axis incremental cost for the AI strategy. Each point represents one simulation with varied inputs. The lower-right region combines health gains and cost savings; uncertainty across all simulations must also be considered.

KyungYi Kim, Sang Yoon Kim, Sung Sik Kim, Jae Hun Kim, Du Hyun Ro, Byung Sun Choi. Cost-Effectiveness of AI-Assisted Kellgren-Lawrence Grading of Knee Osteoarthritis in the South Korean Health-Care System (2026). DOI: 10.2106/JBJS.25.01278 · Figure 4, Original, unchanged.

Evidence & Original SourceImage use terms

Which assumptions change cost-effectiveness?

Original Figure 2: Which assumptions change cost-effectiveness?Enlarge Figure

This analysis varies one input at a time. Longer bars indicate greater influence on the ICER. Results depend on assumptions about utility, nonoperative treatment effectiveness, AI costs, and other inputs.

KyungYi Kim, Sang Yoon Kim, Sung Sik Kim, Jae Hun Kim, Du Hyun Ro, Byung Sun Choi. Cost-Effectiveness of AI-Assisted Kellgren-Lawrence Grading of Knee Osteoarthritis in the South Korean Health-Care System (2026). DOI: 10.2106/JBJS.25.01278 · Figure 2, Original, unchanged.

Evidence & Original SourceImage use terms

Varying nonoperative treatment effects together

Original Figure 3: Varying nonoperative treatment effects togetherEnlarge Figure

This analysis jointly varies the probability of remaining in the same KL category after nonoperative care and the relative effect of adding injections. The colored regions indicate the strategy favored for cost-effectiveness under each assumption, not an individual patient’s probability of treatment success.

KyungYi Kim, Sang Yoon Kim, Sung Sik Kim, Jae Hun Kim, Du Hyun Ro, Byung Sun Choi. Cost-Effectiveness of AI-Assisted Kellgren-Lawrence Grading of Knee Osteoarthritis in the South Korean Health-Care System (2026). DOI: 10.2106/JBJS.25.01278 · Figure 3, Original, unchanged.

Evidence & Original SourceImage use terms

Results explained with study numbers

The model estimated lifetime costs of $137,710 for the AI strategy and $140,834 for usual assessment, with $3,125 lower incremental cost and 0.260 more QALYs.Enlarge Figure

The model estimated lifetime costs of $137,710 for the AI strategy and $140,834 for usual assessment, with $3,125 lower incremental cost and 0.260 more QALYs.

Journal of Bone and Joint Surgery American Volume (2026). DOI: 10.2106/JBJS.25.01278 · Original explanatory chart based on reported data

Evidence & Original SourceImage use terms

The research question

What Is the Lifetime Cost-effectiveness of AI-assisted KL Grading in the Korean Healthcare System?

Participants and Methods

A decision-tree and Markov model simulated disease progression and treatment pathways in a hypothetical cohort aged 50 or older. Costs, QALYs, ICERs and sensitivity analyses were assessed from a healthcare-system perspective. This was a model-based hypothetical cohort, not an intervention trial involving actual patients.

Main Findings

Estimated lifetime cost and QALYs were $137,710 and 22.721 for the AI strategy, versus $140,834 and 22.461 for conventional assessment. The paper reported a $3,125 cost reduction, a 0.260 QALY gain and an ICER of −$12,031/QALY. At a willingness-to-pay threshold of $34,642, the probability of cost-effectiveness in probabilistic sensitivity analysis was 55.1%. Results were sensitive to assumptions about AI costs and the effectiveness of nonsurgical treatment.

Implications for clinical and surgical practice

The study presents a hypothesis about the economic efficiency of imaging AI. It does not establish a guaranteed return on investment in clinical practice or a guaranteed saving per patient.

Limitations

Results depend on the model assumptions. The 55.1% probability of cost-effectiveness in PSA indicates uncertainty. D.H.R. disclosed his role as CEO of CONNECTEVE, which developed the AI being evaluated.

Let's put it briefly.

Which clinical question does this address?

The study presents a hypothesis about the economic efficiency of imaging AI. It does not establish a guaranteed return on investment in clinical practice or a guaranteed saving per patient.

Keywords

Abstract · Original text

KyungYi Kim, Sang Yoon Kim, Sung Sik Kim, Jae Hun Kim, Du Hyun Ro, Byung Sun Choi. Cost-Effectiveness of AI-Assisted Kellgren-Lawrence Grading of Knee Osteoarthritis in the South Korean Health-Care System. The Journal of bone and joint surgery. American volume. 2026. doi:10.2106/JBJS.25.01278.

Excerpt from the original abstract

Early diagnosis of knee osteoarthritis (KOA) is often delayed due to reliance on subjective interpretation of radiographs. Recent advances in artificial intelligence (AI)-based automated Kellgren-Lawrence…
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The original paper.

Cost-Effectiveness of AI-Assisted Kellgren-Lawrence Grading of Knee Osteoarthritis in the South Korean Health-Care System

KyungYi Kim, Sang Yoon Kim, Sung Sik Kim, Jae Hun Kim, Du Hyun Ro, Byung Sun Choi
Journal of Bone and Joint Surgery American Volume · 2026

DOI · 10.2106/JBJS.25.01278PubMedBased data
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