Abstract
Artificial intelligence has empowered precision medicine (AI-PM) to transform healthcare. This study synthesized available evidence on the cost-effectiveness of AI-PM. We systematically searched five major databases for economic evaluations of AI-PM, extracted data, and assessed risk-of-bias using the Bias in Economic Evaluation (ECOBIAS) checklist. For cost-utility analyses, the value-for-money was quantitatively summarized, and regression analyses incorporating machine learning were conducted to explore value heterogeneity. Forty-eight economic evaluations were included, of which 31 were cost-utility analyses. Although risk-of-bias assessment indicated potential systematic optimism, AI-PM was cost-saving or cost-effective in 89% of base-case analyses, with incremental cost-effectiveness ratios ranging from dominant to $129,174/quality-adjusted life-year (QALY). Interquartile ranges of incremental costs (-$259 to $28), QALY gains (0.001-0.019), and net monetary benefits (NMB; $18 to $986 at a willingness-to-pay threshold equal to one-time per-capita GDP) indicated modest health gains at minimal additional costs, and likely high value heterogeneity. Modeling choices and system-level factors were identified as essential sources of heterogeneity in estimated NMBs. Additional value assessment revealed low adaptability and underreported key value factors, leaving significant uncertainties in AI-PM adoption.