Evidence map›Paper›PMID 40218125›Full record

ArticleHealthcare (Basel, Switzerland)2025

Ethical, Legal, and Social Assessment of AI-Based Technologies for Prevention and Diagnosis of Rare Diseases in Health Technology Assessment Processes.

Pietro Refolo, Costanza Raimondi, Violeta Astratinei, Livio Battaglia, Josep M Borràs, Paula Closa, Alessandra Lo Scalzo, Marco Marchetti, Sonia Muñoz-López, Laura Sampietro-Colom and 1 more

Abstract read
In one paragraph

Article in Healthcare (Basel, Switzerland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. ChatGPT in precision medicine.APL bioengineering · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Pietro RefoloDepartment of Health Care Surveillance and Bioethics, Section of Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.ORCID 0000-0003-1055-160X
Costanza RaimondiDepartment of Health Care Surveillance and Bioethics, Section of Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Violeta AstratineiMelanoma Patient Network Europe (MPNE), Fjällbo Selknä 152, 75597 Uppsala, Sweden.
Livio BattagliaNational Agency for Regional Health Services (AGENAS), 00187 Rome, Italy.
Josep M BorràsDepartment of Clinical Sciences, University of Barcelona, 08036 Barcelona, Spain.ORCID 0000-0001-7330-6308
Paula ClosaFundació de Recerca Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain.
Alessandra Lo ScalzoNational Agency for Regional Health Services (AGENAS), 00187 Rome, Italy.
Marco MarchettiNational Agency for Regional Health Services (AGENAS), 00187 Rome, Italy.ORCID 0000-0002-8367-8268
Sonia Muñoz-LópezFundació de Recerca Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain.
Laura Sampietro-ColomFundació de Recerca Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain.ORCID 0000-0001-7182-0231
Dario SacchiniDepartment of Health Care Surveillance and Bioethics, Section of Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.ORCID 0000-0002-1581-3018

Funding

EU Horizon Grant (Melanoma in Childhood, Adolescents,and Young Adults-MELCAYA, HORI-ZON-MISS-2021-CANCER-02) 101096667
6 · The paper itself

Abstract

backgroundWhile the HTA community appears well-equipped to assess preventive and diagnostic technologies, certain limitations persist in evaluating technologies designed for rare diseases, including those based on Artificial Intelligence (AI). In Europe, the EUnetHTA Core Model

methodsAn exploratory sequential mixed methods approach was used, integrating a PICO-guided literature review and a focus group. The review analyzed six peer-reviewed articles and compared the findings with a prior study on childhood melanoma published in this journal (Healthcare), retaining only newly identified issues. A focus group composed of experts in ethical, legal, and social domains provided qualitative insights.

resultsThirteen additional issues and their corresponding questions were identified. Ethical concerns related to rare diseases included insufficient disease history knowledge, lack of robust clinical data, absence of validated efficacy tools, overdiagnosis/underdiagnosis risks, and unknown ICER thresholds. Defensive medicine was identified as a legal issue. For AI-based technologies, concerns included discriminatory outcomes, explicability, and environmental impact (ethical); accountability and reimbursement (legal); and patient involvement and job losses (social).

conclusionsIntegrating these findings into the Core Model enables a comprehensive HTA of AI-based rare disease technologies. Beyond the Core Model, these issues may inform broader assessment frameworks, ensuring rigorous and ethically responsible evaluations.

Indexed as

artificial intelligence (AI)diagnosisethicshealth technology assessment (HTA)legalpreventionrare diseasessocial

Identifiers

PMID40218125
PMCPMC11988925

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.