Optimizing Initial Screening for Colorectal Cancer Detection with Adherence Behavior

85 Pages Posted: 10 Dec 2021 Last revised: 5 Mar 2024

See all articles by Sarah Yini Gao

Sarah Yini Gao

Singapore Management University - Lee Kong Chian School of Business

Yan He

Singapore Management University

Ruijie Zhang

ShanghaiTech University - School of Entrepreneurship and Management; Singapore Management University

Zhichao Zheng

Singapore Management University - Lee Kong Chian School of Business

Sean Lam Shao Wei

National University of Singapore (NUS) - Programme in Health Services and Systems Research; Singapore Health Services Pte Ltd

Date Written: October 28, 2021

Abstract

Two-stage screening programs are widely adopted for early colorectal cancer (CRC) detection. Individuals receiving positive outcomes in the first-stage (initial) test are recommended to undergo a second-stage test (colonoscopy) for further diagnosis. We study the initial test design—i.e., selecting cutoffs to report test outcomes—to balance the trade-off between screening effectiveness (i.e., cancer and polyp detection) and efficiency (i.e., colonoscopy costs), considering that not all individuals adhere to the guidelines to follow up with a colonoscopy after receiving positive outcomes. We integrate the Bayesian persuasion framework with information avoidance to model the problem. We show that under certain conditions, using a single cutoff in the initial test is optimal for follow-up maximization, and a continuous test (i.e., showing exact readings of the biomarker) is optimal for effectiveness maximization. We apply the framework to Singapore’s CRC screening design and calibrate the model using various sources of data, including a nationwide survey with 3,920 responses in Singapore. Our results suggest that compared with the current practice, increasing the cutoff to the level that maximizes expected follow-ups by cancer and polyp patients can detect 20.83% more CRC and polyp incidences, reduce 26.98% colonoscopies, lower public healthcare expenditure by S$46.73 million and individual spending by S$28.04 million on average for screening costs, and lower lifetime risk of CRC by 11.03%. The current practice of using lower cutoffs to achieve high sensitivity can backfire and lead to excessive unnecessary colonoscopies and low adherence.

Note:
Funding Information: None to declare.

Declaration of Interests: None to declare.

Keywords: Cancer Screening; Cutoff Selection; Adherence; Bayesian Persuasion; Information Avoidance

Suggested Citation

Gao, Sarah Yini and He, Yan and Zhang, Ruijie and Zheng, Zhichao and Wei, Sean Lam Shao, Optimizing Initial Screening for Colorectal Cancer Detection with Adherence Behavior (October 28, 2021). Available at SSRN: https://ssrn.com/abstract=3951864 or http://dx.doi.org/10.2139/ssrn.3951864

Sarah Yini Gao

Singapore Management University - Lee Kong Chian School of Business ( email )

469 Bukit Timah Road
Singapore 912409
Singapore

Yan He

Singapore Management University ( email )

Li Ka Shing Library
70 Stamford Road
Singapore 178901, 178899
Singapore

Ruijie Zhang

ShanghaiTech University - School of Entrepreneurship and Management ( email )

100 Haike Rd
Pudong Xinqu, Shanghai
China

Singapore Management University ( email )

Li Ka Shing Library
70 Stamford Road
Singapore 178901, 178899
Singapore

Zhichao Zheng (Contact Author)

Singapore Management University - Lee Kong Chian School of Business ( email )

50 Stamford Road
Singapore, 178899
Singapore
(65) 6808 5474 (Phone)
(65) 6828 0777 (Fax)

HOME PAGE: http://www.zhengzhichao.com

Sean Lam Shao Wei

National University of Singapore (NUS) - Programme in Health Services and Systems Research ( email )

8 College Road
Singapore
Singapore

Singapore Health Services Pte Ltd ( email )

7 Hospital Drive
Block A, Room #02-01
Singapore, 597627
Singapore

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