Prospective comparison of travel burden, cost and time to obtain tumour board treatment plan through in-person visits vs an AI enabled health technology (N = 1803)

Abstract

Background: NAVYA is a validated online cancer informatics solution that combines artificial intelligence (AI) and rapid review (2 mins/case) by multi-disciplinary tumor board experts at Academic Medical Centers (AMC) to deliver multidisciplinary expert treatment plan to patientswithin 24 hours. Initially developed for patients in Indiawithout ready access to expertise, over 28,000 patients across 68 countries have since reached out toNAVYA. Prior research (SABCS and ASCO2014-2018) showed, 1) 97%concordance ofNAVYA with an AMC in India and in theUS 2) 97%of patients experienced significant anxiety relief due to 24 hours turnaround time.NAVYA scales access to expertise unlike the limitations of synchronized 1 patient: 1 doctor consults in telemedicine. Methods: Three patient centered outcomes (travel distance, cost and time to receive expert treatment plan) were studied. All consecutive patients who reached out to NAVYA between 1/1/17-1/31/19 but ultimately opted for in-person visit to an AMC were contacted by prospective phone follow up. This was compared to a numerically balanced random sample of patients who only used NAVYA to obtain treatment plans. Results: Prospective phone follow-ups with 902 in-person patients and 901 NAVYA patients were analyzed. The groups did not differ significantly in demographics or disease characteristics. In-person patients and NAVYA patients differed significantly with respect to 1) median travel distance (761 miles, IQR (152 -1083 miles) vs. 0 miles (p<0.05)) 2) travel related costs of $1250 [95% CI+/- $54.5] vs $105 online processing fee 3) total time to receipt of treatment plan (4.66 days, IQR (0.4 - 20.3 days) vs. 1.04 day IQR (0.4-2.5) (p<0.05)). Conclusions: Cancer informatics solutions that combine AI with human clinical expertise to generate multidisciplinary treatment plans tailored to an individual patient, and vetted by experts at AMC, scale ready access to expertise around the world. For patients with limited access to AMC, such solutions eliminate travel burden, and significantly reduce cost and wait time. This has significant implications for creating access to specialty expertise, globally.