RT Journal Article
T1 Leveling up: Treating Uptake as Endogenous May Increase the Value of Screening Programs.
A1 Robles-Zurita, José Antonio
A1 Hawkins, Neil
A1 Bouttell, Janet
K1 Política sanitaria - Aspectos económicos
AB Background. We aimed to illustrate that health economists should consider individual heterogeneity when solving theproblem of finding the optimal combination of sensitivity and specificity that maximizes the average health utility ofa target population in a screening program. Methods. A theoretical framework compares the solution under standardeconomics of diagnoses to the optimal combination under an endogenous uptake analysis, where screening participationis given by heterogenous health preferences. An applied example used calibrated parameters with real data fromthe bowel cancer screening program in the United Kingdom. Scenario analyses show how the results would changewith parameter values, if disease risk and health utilities were not independent and if screening uptake were not completelydetermined by health preferences. Results. A general theoretical result states that the endogenous uptake analysisleads to a weakly higher true- and false-positive rate than would be optimal under the standard approach. In thesame way, the endogenous solution would lead to a lower uptake rate. The base-case scenario of the applied exampleillustrates that a screening program using the endogenous solution would generate 21.1% more quality-adjusted lifeyearsthan when using the standard solution. The scenario analyses show when the endogenous analysis is mostvalued and that the general result applies for a wide range of situations when theoretical assumptions are relaxed.Limitations. The results obtained are valid under the assumptions made. Analysts should evaluate if those could holdin the applied screening context. Conclusions. Individual heterogeneity and uptake decisions are relevant factors toconsider in the problem of finding an optimal combination of sensitivity and specificity for a screening test.
PB Sage
YR 2025
FD 2025
LK https://hdl.handle.net/10630/38232
UL https://hdl.handle.net/10630/38232
LA eng
NO Robles-Zurita JA, Hawkins N, Bouttell J. Leveling up: Treating Uptake as Endogenous May Increase the Value of Screening Programs. Medical Decision Making. 2025;45(3):318-331. doi:10.1177/0272989X251319794
NO https://openpolicyfinder.jisc.ac.uk/id/publication/9385
DS RIUMA. Repositorio Institucional de la Universidad de Málaga
RD 20 ene 2026