Early diagnosis of malignant skin tumors using a software product based on artificial intelligence and its medical and economic effect.
Authors: Sivodedova N. A. ,   Public Health of the Federal State Budgetary Educational Institution «PIMU» of the Ministry of Health of Russia, Karyakin N. N. , Shlivko I. L. ,   State Autonomous Healthcare Institution of the Nizhny Novgorod Region “Research Institute of Clinical Oncology “Nizhny Novgorod Regional Clinical Oncology Dispensary”,   Public Health of the Federal State Budgetary Educational Institution «PIMU» of the Ministry of Health of Russia,   Federal State Budgetary Institution of Higher Education «Volga Research Medical University» of the Ministry of Health of Russia
Published: July 2024

Malignant neoplasms of the skin (hereinafter referred to as MNC) occupy a leading place in the structure of oncological diseases in the Russian Federation (female population: MNC – 13.4%, skin melanoma (hereinafter MC) – 2.2%; male population: MNC – 9.8%, MK – 1.73%). Over the past 10 years, there has been an increasing incidence of MNC [1]. The emergence of new treatment methods leads to increased effectiveness, but at the same time, the cost of treatment invariably increases. In the Russian Federation, the main share of costs for MC are direct medical costs (52%). Indirect costs amount to 14%, which is associated with the onset of disability, since the disease is typical for people of working age. direct non-medical costs, despite the small size of social benefits, also constitute a significant part of the total economic burden (about 34%). [2]. The costs of caring for a patient with early-stage MС are significantly lower than for caring for a patient in unresectable stage III/IV. [3],[4],[5],[6]. At the same time, radical surgical treatment of stage I melanoma can increase the number of positive outcomes for skin melanoma. [8] In general, it can be stated that diagnosing MС at late stages leads to an increase in the cost of treatment. In addition to the above, it should be noted that primary health care specialists are the first to face the problem of differential diagnosis of cancer with benign skin tumors. [9], [10] When conducting a visual examination by these specialists, the sensitivity of MC recognition is 40.2%, which is two times lower than that of an experienced dermatologist (92%) [11], [12]. Considering the seriousness of the identified problems, the search and implementation of new approaches for the early detection of cancer are coming to the fore. Possible solutions include the various methods recently proposed for the early detection of cancer in the form of the use of mobile applications based on artificial intelligence and teledermatology, which can expand the capabilities of imaging systems and help primary care specialists identify cancer [13], [14], [15], [16], [17], [18]. An equally pressing issue remains the implementation of an effective system for the prevention and early diagnosis of cancer, which would include mass screening of the population at the pre-outpatient stage and the use of modern diagnostic methods in the form of mobile applications at the outpatient stage, for any reason the patient visits a primary care doctor. Since 2023, in two regions of the Russian Federation (Nizhny Novgorod region, Republic of Tatarstan), a pilot project «Region without melanoma» has been carried out, the implementation of which is supported by the «Priority 2030» program of the national project «Science and Universities». The project includes mass screening of the population for the presence of cancer using the «ProRodinki» mobile application. To expedite the routing of patients to an oncologist with suspected cancer, a direct call line has been established in the oncology clinic in the region. In December 2023, the application received the status of a medical device, which allows primary care physicians to widely use the mobile application for the early detection of cancer, subject to its integration into the Unified State Health Information System (the unified state health information system of the region). Purpose: to evaluate the medical and economic effectiveness of the program for early diagnosis of cancer «Region without melanoma» at the pre-outpatient stage at the regional level using a mobile application. Material and methods. The work used a telephone survey of users from different regions of the Russian Federation of the «ProRodinki» application, who received a notification about the need to see a doctor, therefore, they were identified as having a high risk of malignant skin tumors. The telephone survey was conducted by student volunteers of the Volga Region Research Medical University of the Russian Ministry of Health (hereinafter referred to as PIMU) based on a questionnaire developed jointly by the Department of Skin and Sexually Transmitted Diseases and the Department of General and Clinical Psychology. The «ProRodinki» application was developed by employees of the department of skin and sexually transmitted diseases of PIMU and specialists in the field of IT technologies of AIMED LLC with the support of the state autonomous healthcare institution of the Nizhny Novgorod region «Research Institute of Clinical Oncology» Nizhny Novgorod Regional Clinical Oncology Dispensary [19] The database and computer program have state registration dated November 19, 2020. No. 2020664964. According to the conclusion of Roszdravnadzor, PP «ProRodinki» is a medical product of class 1 potential risk of use dated December 27, 2023. No. RZN2023/21776 (Service for supporting medical decision making for the diagnosis of skin tumors ProRodinki according to TU58.29.32–001–43490523–2022.) The study also assessed the cost of treatment in 148 patients with МС stage I (38 people), stage II (46 people), stage III (34 people), stage IV (30 people) in the Russian Federation for the period 2022 in comparison with the cost treatment according to clinical recommendations of the Russian Federation. Conclusion. The results obtained can indicate the effectiveness of the social project «Region without Melanoma», since modern approaches implemented within the program show significant results. Increasing the coverage of the population with diagnostic testing to detect cancer is an important component of increasing the effectiveness of treatment for this group of diseases. At the preoutpatient stage, it is promising to introduce the use of a modern diagnostic method for mass screening of the population for the presence of cancer using the «ProRodinki» mobile application. Also, encouraging results have been obtained regarding the early detection of MС, which can lead to an increase in positive outcomes of the disease. In addition, according to the data obtained, detection at earlier stages leads to a reduction in treatment costs, helping to save the healthcare budget. In general, the search and implementation of new modern approaches has broad potential and is likely to significantly increase the efficiency of the healthcare system, in particular in the detection and treatment of cancer.