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Modeling and Optimization in Early Detection Programs with a Single Exam

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The choice of timing of screening examinations is an important element in determining the efficacy of strategies for the early detection of occult disease. In this article, we describe a flexible decision-making framework for the design of early detection programs, and we investigate the choice of timing when each individual in the screening program is examined only once. We focus on the theoretical relation between the optimal examination time and the distributions of sojourn times in health-related states. Specifically, we derive closed-form solutions of the optimal age using two specifications of utility functions, discuss the effects of natural history and utility specifications on the optimal solution, and present an application to early detection of colorectal cancer by once-only sigmoidoscopy or colonoscopy.

Keywords: Chronic disease; Colorectal cancer screening; Competing risks; Decision analysis; Overdiagnosis

Document Type: Research Article


Affiliations: 1: Departments of Oncology, Biostatistics, and Pathology, Johns Hopkins University, Baltimore, Maryland 21205, U.S.A. 2: Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, U.S.A. 3: Harvard School of Public Health and Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, Massachusetts, U.S.A.

Publication date: March 1, 2002

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