What is the role of human decisions in a world of artificial intelligence: an economic evaluation of human-AI collaboration in diabetic retinopathy screening

As Artificial intelligence (AI) has been increasingly integrated into the medical field, the role of humans may become vague. While numerous studies highlight AI's potential, how humans and AI collaborate to maximize the combined clinical benefits remains unexplored. In this work, we analyze 270 screening scenarios from a health-economic perspective in a national diabetic retinopathy screening program, involving eight human-AI collaborative strategies and traditional manual screening. We find that annual copilot human-AI screening in the 20-79 age group, with referral decisions made when both humans and AI agree, is the most cost-effective strategy for human-AI collaboration. The 'copilot' strategy brings health benefits equivalent to USD 4.64 million per 100,000 population compared to manual screening. These findings demonstrate that even in settings where AI is highly mature and efficient, human involvement remains essential to ensuring both health and economic benefits. Our findings highlight the need to optimize human-AI collaboration strategies for AI implementation into healthcare systems.