Xiaoyan Wang

Rachael Fleurence, Jiang Bian, Xiaoyan Wang et al.

This review introduces the transformative potential of generative Artificial Intelligence (AI) and foundation models, including large language models (LLMs), for health technology assessment (HTA). We explore their applications in four critical areas, evidence synthesis, evidence generation, clinical trials and economic modeling: (1) Evidence synthesis: Generative AI has the potential to assist in automating literature reviews and meta-analyses by proposing search terms, screening abstracts, and extracting data with notable accuracy; (2) Evidence generation: These models can potentially facilitate automating the process and analyze the increasingly available large collections of real-world data (RWD), including unstructured clinical notes and imaging, enhancing the speed and quality of real-world evidence (RWE) generation; (3) Clinical trials: Generative AI can be used to optimize trial design, improve patient matching, and manage trial data more efficiently; and (4) Economic modeling: Generative AI can also aid in the development of health economic models, from conceptualization to validation, thus streamlining the overall HTA process. Despite their promise, these technologies, while rapidly improving, are still nascent and continued careful evaluation in their applications to HTA is required. To ensure their responsible use and implementation, both developers and users of research incorporating these tools, should familiarize themselves with their current limitations, including the issues related to scientific validity, risk of bias, and consider equity and ethical implications. We also surveyed the current policy landscape and provide suggestions for HTA agencies on responsibly integrating generative AI into their workflows, emphasizing the importance of human oversight and the fast-evolving nature of these tools.

Rachael Fleurence, Xiaoyan Wang, Jiang Bian et al.

Objective: This article offers a taxonomy of generative artificial intelligence (AI) for health economics and outcomes research (HEOR), explores its emerging applications, and outlines methods to enhance the accuracy and reliability of AI-generated outputs. Methods: The review defines foundational generative AI concepts and highlights current HEOR applications, including systematic literature reviews, health economic modeling, real-world evidence generation, and dossier development. Approaches such as prompt engineering (zero-shot, few-shot, chain-of-thought, persona pattern prompting), retrieval-augmented generation, model fine-tuning, and the use of domain-specific models are introduced to improve AI accuracy and reliability. Results: Generative AI shows significant potential in HEOR, enhancing efficiency, productivity, and offering novel solutions to complex challenges. Foundation models are promising in automating complex tasks, though challenges remain in scientific reliability, bias, interpretability, and workflow integration. The article discusses strategies to improve the accuracy of these AI tools. Conclusion: Generative AI could transform HEOR by increasing efficiency and accuracy across various applications. However, its full potential can only be realized by building HEOR expertise and addressing the limitations of current AI technologies. As AI evolves, ongoing research and innovation will shape its future role in the field.

Rachael L. Fleurence, Dalia Dawoud, Jiang Bian et al.

Introduction: Generative artificial intelligence (AI), particularly large language models (LLMs), holds significant promise for Health Economics and Outcomes Research (HEOR). However, standardized reporting guidance for LLM-assisted research is lacking. This article introduces the ELEVATE GenAI framework and checklist - reporting guidelines specifically designed for HEOR studies involving LLMs. Methods: The framework was developed through a targeted literature review of existing reporting guidelines, AI evaluation frameworks, and expert input from the ISPOR Working Group on Generative AI. It comprises ten domains, including model characteristics, accuracy, reproducibility, and fairness and bias. The accompanying checklist translates the framework into actionable reporting items. To illustrate its use, the framework was applied to two published HEOR studies: one focused on systematic literature review tasks and the other on economic modeling. Results: The ELEVATE GenAI framework offers a comprehensive structure for reporting LLM-assisted HEOR research, while the checklist facilitates practical implementation. Its application to the two case studies demonstrates its relevance and usability across different HEOR contexts. Limitations: Although the framework provides robust reporting guidance, further empirical testing is needed to assess its validity, completeness, usability, as well as its generalizability across diverse HEOR use cases. Conclusion: The ELEVATE GenAI framework and checklist address a critical gap by offering structured guidance for transparent, accurate, and reproducible reporting of LLM-assisted HEOR research. Future work will focus on extensive testing and validation to support broader adoption and refinement.

Juan He, Xiaoyan Wang, Long Chen et al.

Wound healing is a complex process involving changes in collagen fibers. Accurate monitoring of these changes is crucial for assessing the progress of wound healing and has significant implications for guiding clinical treatment strategies and drug screening. However, traditional quantitative analysis methods focus on spatial characteristics such as collagen fiber alignment and variance, lacking threshold standards to differentiate between different stages of wound healing. To address this issue, we propose an innovative approach based on deep learning to predict the progression of wound healing by analyzing collagen fiber features in histological images of wound tissue. Leveraging the unique learning capabilities of deep learning models, our approach captures the feature variations of collagen fibers in histological images from different categories and classifies them into various stages of wound healing. To overcome the limited availability of histological image data, we employ a transfer learning strategy. Specifically, we fine-tune a VGG16 model pretrained on the ImageNet dataset to adapt it to the classification task of histological images of wounds. Through this process, our model achieves 82% accuracy in classifying six stages of wound healing. Furthermore, to enhance the interpretability of the model, we employ a class activation mapping technique called LayerCAM. LayerCAM reveals the image regions on which the model relies when making predictions, providing transparency to the model's decision-making process. This visualization not only helps us understand how the model identifies and evaluates collagen fiber features but also enhances trust in the model's prediction results. To the best of our knowledge, our proposed model is the first deep learning-based classification model used for predicting wound healing stages.

Xiaoyang Wang, Christopher C. Yang

Healthcare systems generate diverse multimodal data, including Electronic Health Records (EHR), clinical notes, and medical images. Effectively leveraging this data for clinical prediction is challenging, particularly as real-world samples often present with varied or incomplete modalities. Existing approaches typically require complete modality data or rely on manual selection strategies, limiting their applicability in real-world clinical settings where data availability varies across patients and institutions. To address these limitations, we propose MoE-Health, a novel Mixture of Experts framework designed for robust multimodal fusion in healthcare prediction. MoE-Health architecture is specifically developed to handle samples with differing modalities and improve performance on critical clinical tasks. By leveraging specialized expert networks and a dynamic gating mechanism, our approach dynamically selects and combines relevant experts based on available data modalities, enabling flexible adaptation to varying data availability scenarios. We evaluate MoE-Health on the MIMIC-IV dataset across three critical clinical prediction tasks: in-hospital mortality prediction, long length of stay, and hospital readmission prediction. Experimental results demonstrate that MoE-Health achieves superior performance compared to existing multimodal fusion methods while maintaining robustness across different modality availability patterns. The framework effectively integrates multimodal information, offering improved predictive performance and robustness in handling heterogeneous and incomplete healthcare data, making it particularly suitable for deployment in diverse healthcare environments with heterogeneous data availability.

Xiaoyang Wang, Christopher C. Yang

Artificial intelligence (AI) systems in healthcare have demonstrated remarkable potential to improve patient outcomes. However, if not designed with fairness in mind, they also carry the risks of perpetuating or exacerbating existing health disparities. Although numerous fairness-enhancing techniques have been proposed, most focus on a single sensitive attribute and neglect the broader impact that optimizing fairness for one attribute may have on the fairness of other sensitive attributes. In this work, we introduce a novel approach to multi-attribute fairness optimization in healthcare AI, tackling fairness concerns across multiple demographic attributes concurrently. Our method follows a two-phase approach: initially optimizing for predictive performance, followed by fine-tuning to achieve fairness across multiple sensitive attributes. We develop our proposed method using two strategies, sequential and simultaneous. Our results show a significant reduction in Equalized Odds Disparity (EOD) for multiple attributes, while maintaining high predictive accuracy. Notably, we demonstrate that single-attribute fairness methods can inadvertently increase disparities in non-targeted attributes whereas simultaneous multi-attribute optimization achieves more balanced fairness improvements across all attributes. These findings highlight the importance of comprehensive fairness strategies in healthcare AI and offer promising directions for future research in this critical area.