CoAI: Cost-Aware Artificial Intelligence for Health Care

The recent emergence of accurate artificial intelligence (AI) models for disease diagnosis raises the possibility that AI-based clinical decision support could substantially lower the workload of healthcare providers. However, for this to occur, the input data to an AI predictive model, i.e., the patient’s features, must themselves be low-cost, that is, efficient, inexpensive, or low-effort to acquire. When time or financial resources for gathering data are limited, as in emergency or critical care medicine, modern high-accuracy AI models that use thousands of patient features are likely impractical. To address this problem, we developed the CoAI (Cost-aware AI) framework to enable any kind of AI predictive model (e.g., deep neural networks, tree ensemble models, etc.) to make accurate predictions given a small number of low-cost features. We show that CoAI dramatically reduces the cost of predicting prehospital acute traumatic coagulopathy, intensive care mortality, and outpatient mortality relative to existing risk scores, while improving prediction accuracy. It also outperforms existing state-of-the-art cost-sensitive prediction approaches in terms of predictive performance, model cost, and training time. Extrapolating these results to all trauma patients in the United States shows that, at a fixed false positive rate, CoAI could alert providers of tens of thousands more dangerous events than other risk scores while reducing providers’ data-gathering time by about 90 percent, leading to a savings of 200,000 cumulative hours per year across all providers. We extrapolate similar increases in clinical utility for CoAI in intensive care. These benefits stem from several unique strengths: First, CoAI uses axiomatic feature attribution methods that enable precise estimation of feature importance. Second, CoAI is model-agnostic, allowing users to choose the predictive model that performs the best for the prediction task and data at hand. Finally, unlike many existing methods, CoAI finds high-performance models within a given budget without any tuning of the cost-vs-performance tradeoff. We believe CoAI will dramatically improve patient care in the domains of medicine in which predictions need to be made with limited time and resources.