Preference-Sensitive Management of Post-Mammography Decisions in Breast Cancer Diagnosis

Forthcoming, Production and Operations Management.

55 Pages Posted: 28 Nov 2017 Last revised: 21 Sep 2018

See all articles by Mehmet Ayvaci

Mehmet Ayvaci

University of Texas at Dallas - Department of Information Systems & Operations Management

Oguzhan Alagoz

University of Wisconsin - Madison - Department of Industrial and Systems Engineering

M. Eren Ahsen

Mount Sinai Health System - Icahn School of Medicine

Elizabeth Burnside

University of Wisconsin - Madison - School of Medicine and Public Health

Date Written: April 28, 2018

Abstract

Decision models representing the clinical situations where treatment options entail a significant risk of morbidity or mortality should consider the variations in risk preferences of individuals. In this study, we develop a stochastic modeling framework that optimizes risk-sensitive diagnostic decisions after a mammography exam. For a given patient, our objective is to find the utility maximizing diagnostic decisions where we define the utility over quality-adjusted survival duration. We use real data from a private mammography database to numerically solve our model for various utility functions. Our choice of utility functions for the numerical analysis is driven by actual patient behavior encountered in clinical practice. We find that invasive diagnostic procedures such as biopsies are more aggressively used than what the optimal risk-neutral policy would suggest, implying a far-sighted (or equivalently risk-seeking) behavior. When risk preferences are incorporated into the clinical practice, policy makers should bear in mind that a welfare loss in terms of survival duration is inevitable as evidenced by our structural and empirical results.

Keywords: Risk-Sensitive Markov Decision Processes, Dynamic Programming, Breast Cancer, Preferences, Medical Decision-Making, Utility Theory, Healthcare Analytics

JEL Classification: I12

Suggested Citation

Ayvaci, Mehmet and Alagoz, Oguzhan and Ahsen, M. Eren and Burnside, Elizabeth, Preference-Sensitive Management of Post-Mammography Decisions in Breast Cancer Diagnosis (April 28, 2018). Forthcoming, Production and Operations Management.. Available at SSRN: https://ssrn.com/abstract=3073647 or http://dx.doi.org/10.2139/ssrn.3073647

Mehmet Ayvaci (Contact Author)

University of Texas at Dallas - Department of Information Systems & Operations Management ( email )

P.O. Box 830688
Richardson, TX 75083-0688
United States

Oguzhan Alagoz

University of Wisconsin - Madison - Department of Industrial and Systems Engineering ( email )

360 Mechanical Engineering
1513 University Avenue
Madison, WI 53706-1572
United States

M. Eren Ahsen

Mount Sinai Health System - Icahn School of Medicine ( email )

1 Gustave L. Levy Pl
New York, NY 10029
United States

Elizabeth Burnside

University of Wisconsin - Madison - School of Medicine and Public Health ( email )

Madison, WI 53711
United States

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