title: Timing of testing and treatment for asymptomatic diseases.
abstract: Many papers in the medical literature analyze the cost-effectiveness of screening for diseases by comparing a limited number of a priori testing policies under estimated problem parameters. However, this may be insufficient to determine the best timing of the tests or incorporate changes over time. In this paper, we develop and solve a Markov Decision Process (MDP) model for a simple class of asymptomatic diseases in order to provide the building blocks for analysis of a more general class of diseases. We provide a computationally efficient method for determining a cost-effective dynamic intervention strategy that takes into account (i) the results of the previous test for each individual and (ii) the change in the individual's behavior based on awareness of the disease. We demonstrate the usefulness of the approach by applying the results to screening decisions for Hepatitis C (HCV) using medical data, and compare our findings to current HCV screening recommendations.
authors.affiliation: State University of New York - Binghamton, School of Management, P.O. Box 6000, Binghamton, NY 13902, USA. eser@binghamton.edu
authors.forename: Eser
authors.initials: E
authors.lastname: Kirkizlar
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Faissol
authors.forename: Paul M
authors.initials: PM
authors.lastname: Griffin
authors.forename: Julie L
authors.initials: JL
authors.lastname: Swann
mesh_terms: D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003662:Decision Theory; D003933:Diagnosis; D004194:Disease / Q000191:economics; D006526:Hepatitis C / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D015233:Models, Statistical; D013269:Stochastic Processes; D013812:Therapeutics / Q000706:statistics & numerical data*; D013997:Time Factors