IDEAS home Printed from https://ideas.repec.org/a/inm/ormsom/v14y2012i4p600-617.html
   My bibliography  Save this article

The Effect of Budgetary Restrictions on Breast Cancer Diagnostic Decisions

Author

Listed:
  • Mehmet U. S. Ayvaci

    (Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706)

  • Oguzhan Alagoz

    (Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706)

  • Elizabeth S. Burnside

    (Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin 53792)

Abstract

We develop a finite-horizon discrete-time constrained Markov decision process (MDP) to model diagnostic decisions after mammography where we maximize the total expected quality-adjusted life years (QALYs) of a patient under resource constraints. We use clinical data to estimate the parameters of the MDP model and solve it as a mixed-integer program. By repeating optimization for a sequence of budget levels, we calculate incremental cost-effectiveness ratios attributable to consecutive levels of funding and compare actual clinical practice with optimal decisions. We prove that the optimal value function is concave in the allocated budget. Comparing to actual clinical practice, using optimal thresholds for decision making may result in approximately 22% cost savings without sacrificing QALYs. Our analysis indicates short-term follow-ups are the immediate target for elimination when budget becomes a concern. Policy change is more drastic in the older age group with the increasing budget, yet the gains in total expected QALYs related to larger budgets are predominantly seen in younger women along with modest gains for older women.

Suggested Citation

  • Mehmet U. S. Ayvaci & Oguzhan Alagoz & Elizabeth S. Burnside, 2012. "The Effect of Budgetary Restrictions on Breast Cancer Diagnostic Decisions," Manufacturing & Service Operations Management, INFORMS, vol. 14(4), pages 600-617, October.
    • Handle: RePEc:inm:ormsom:v:14:y:2012:i:4:p:600-617
    DOI: 10.1287/msom.1110.0371
    as

    Download full text from publisher

    File URL: http://dx.doi.org/10.1287/msom.1110.0371
    Download Restriction: no
    File URL: https://libkey.io/10.1287/msom.1110.0371?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Jagpreet Chhatwal & Oguzhan Alagoz & Elizabeth S. Burnside, 2010. "Optimal Breast Biopsy Decision-Making Based on Mammographic Features and Demographic Factors," Operations Research, INFORMS, vol. 58(6), pages 1577-1591, December.
    2. Turgay Ayer & Oguzhan Alagoz & Natasha K. Stout, 2012. "OR Forum---A POMDP Approach to Personalize Mammography Screening Decisions," Operations Research, INFORMS, vol. 60(5), pages 1019-1034, October.
    3. Alan S. Manne, 1960. "Linear Programming and Sequential Decisions," Management Science, INFORMS, vol. 6(3), pages 259-267, April.
    4. Burhaneddin Sandıkçı & Lisa M. Maillart & Andrew J. Schaefer & Oguzhan Alagoz & Mark S. Roberts, 2008. "Estimating the Patient's Price of Privacy in Liver Transplantation," Operations Research, INFORMS, vol. 56(6), pages 1393-1410, December.
    5. Lisa M. Maillart & Julie Simmons Ivy & Scott Ransom & Kathleen Diehl, 2008. "Assessing Dynamic Breast Cancer Screening Policies," Operations Research, INFORMS, vol. 56(6), pages 1411-1427, December.
    6. Chris P. Lee & Glenn M. Chertow & Stefanos A. Zenios, 2008. "Optimal Initiation and Management of Dialysis Therapy," Operations Research, INFORMS, vol. 56(6), pages 1428-1449, December.
    7. Cyrus Derman & Morton Klein, 1965. "Some Remarks on Finite Horizon Markovian Decision Models," Operations Research, INFORMS, vol. 13(2), pages 272-278, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Robert Kraig Helmeczi & Can Kavaklioglu & Mucahit Cevik & Davood Pirayesh Neghab, 2023. "A multi-objective constrained partially observable Markov decision process model for breast cancer screening," Operational Research, Springer, vol. 23(2), pages 1-42, June.
    2. Malek Ebadi & Raha Akhavan-Tabatabaei, 2021. "Personalized Cotesting Policies for Cervical Cancer Screening: A POMDP Approach," Mathematics, MDPI, vol. 9(6), pages 1-20, March.
    3. Mehmet A. Ergun & Ali Hajjar & Oguzhan Alagoz & Murtuza Rampurwala, 2022. "Optimal breast cancer risk reduction policies tailored to personal risk level," Health Care Management Science, Springer, vol. 25(3), pages 363-388, September.
    4. M. Reza Skandari & Steven M. Shechter, 2021. "Patient-Type Bayes-Adaptive Treatment Plans," Operations Research, INFORMS, vol. 69(2), pages 574-598, March.
    5. Muge Capan & Anahita Khojandi & Brian T. Denton & Kimberly D. Williams & Turgay Ayer & Jagpreet Chhatwal & Murat Kurt & Jennifer Mason Lobo & Mark S. Roberts & Greg Zaric & Shengfan Zhang & J. Sanford, 2017. "From Data to Improved Decisions: Operations Research in Healthcare Delivery," Medical Decision Making, , vol. 37(8), pages 849-859, November.
    6. Otten, Maarten & Timmer, Judith & Witteveen, Annemieke, 2020. "Stratified breast cancer follow-up using a continuous state partially observable Markov decision process," European Journal of Operational Research, Elsevier, vol. 281(2), pages 464-474.
    7. M. Reza Skandari & Steven M. Shechter & Nadia Zalunardo, 2015. "Optimal Vascular Access Choice for Patients on Hemodialysis," Manufacturing & Service Operations Management, INFORMS, vol. 17(4), pages 608-619, October.
    8. Wang, Fan & Zhang, Shengfan & Henderson, Louise M., 2018. "Adaptive decision-making of breast cancer mammography screening: A heuristic-based regression model," Omega, Elsevier, vol. 76(C), pages 70-84.
    9. Elliot Lee & Mariel Lavieri & Michael Volk & Yongcai Xu, 2015. "Applying reinforcement learning techniques to detect hepatocellular carcinoma under limited screening capacity," Health Care Management Science, Springer, vol. 18(3), pages 363-375, September.
    10. Sait Tunç & Oguzhan Alagoz & Elizabeth S. Burnside, 2022. "A new perspective on breast cancer diagnostic guidelines to reduce overdiagnosis," Production and Operations Management, Production and Operations Management Society, vol. 31(5), pages 2361-2378, May.
    11. Pinar Keskinocak & Nicos Savva, 2020. "A Review of the Healthcare-Management (Modeling) Literature Published in Manufacturing & Service Operations Management," Manufacturing & Service Operations Management, INFORMS, vol. 22(1), pages 59-72, January.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hossein Kamalzadeh & Vishal Ahuja & Michael Hahsler & Michael E. Bowen, 2021. "An Analytics‐Driven Approach for Optimal Individualized Diabetes Screening," Production and Operations Management, Production and Operations Management Society, vol. 30(9), pages 3161-3191, September.
    2. Jonathan E. Helm & Mariel S. Lavieri & Mark P. Van Oyen & Joshua D. Stein & David C. Musch, 2015. "Dynamic Forecasting and Control Algorithms of Glaucoma Progression for Clinician Decision Support," Operations Research, INFORMS, vol. 63(5), pages 979-999, October.
    3. Elliot Lee & Mariel Lavieri & Michael Volk & Yongcai Xu, 2015. "Applying reinforcement learning techniques to detect hepatocellular carcinoma under limited screening capacity," Health Care Management Science, Springer, vol. 18(3), pages 363-375, September.
    4. Robert Kraig Helmeczi & Can Kavaklioglu & Mucahit Cevik & Davood Pirayesh Neghab, 2023. "A multi-objective constrained partially observable Markov decision process model for breast cancer screening," Operational Research, Springer, vol. 23(2), pages 1-42, June.
    5. M. Reza Skandari & Steven M. Shechter & Nadia Zalunardo, 2015. "Optimal Vascular Access Choice for Patients on Hemodialysis," Manufacturing & Service Operations Management, INFORMS, vol. 17(4), pages 608-619, October.
    6. Mehmet A. Ergun & Ali Hajjar & Oguzhan Alagoz & Murtuza Rampurwala, 2022. "Optimal breast cancer risk reduction policies tailored to personal risk level," Health Care Management Science, Springer, vol. 25(3), pages 363-388, September.
    7. Wang, Fan & Zhang, Shengfan & Henderson, Louise M., 2018. "Adaptive decision-making of breast cancer mammography screening: A heuristic-based regression model," Omega, Elsevier, vol. 76(C), pages 70-84.
    8. Zlatana Nenova & Jennifer Shang, 2022. "Personalized Chronic Disease Follow‐Up Appointments: Risk‐Stratified Care Through Big Data," Production and Operations Management, Production and Operations Management Society, vol. 31(2), pages 583-606, February.
    9. Elliot Lee & Mariel S. Lavieri & Michael Volk, 2019. "Optimal Screening for Hepatocellular Carcinoma: A Restless Bandit Model," Service Science, INFORMS, vol. 21(1), pages 198-212, January.
    10. Alireza Sabouri & Woonghee Tim Huh & Steven M. Shechter, 2017. "Screening Strategies for Patients on the Kidney Transplant Waiting List," Operations Research, INFORMS, vol. 65(5), pages 1131-1146, October.
    11. Ting-Yu Ho & Shan Liu & Zelda B. Zabinsky, 2019. "A Multi-Fidelity Rollout Algorithm for Dynamic Resource Allocation in Population Disease Management," Health Care Management Science, Springer, vol. 22(4), pages 727-755, December.
    12. Kotas, Jakob & Ghate, Archis, 2018. "Bayesian learning of dose–response parameters from a cohort under response-guided dosing," European Journal of Operational Research, Elsevier, vol. 265(1), pages 328-343.
    13. Burhaneddin Sandıkçı & Lisa M. Maillart & Andrew J. Schaefer & Mark S. Roberts, 2013. "Alleviating the Patient's Price of Privacy Through a Partially Observable Waiting List," Management Science, INFORMS, vol. 59(8), pages 1836-1854, August.
    14. Sait Tunç & Oguzhan Alagoz & Elizabeth S. Burnside, 2022. "A new perspective on breast cancer diagnostic guidelines to reduce overdiagnosis," Production and Operations Management, Production and Operations Management Society, vol. 31(5), pages 2361-2378, May.
    15. Eike Nohdurft & Elisa Long & Stefan Spinler, 2017. "Was Angelina Jolie Right? Optimizing Cancer Prevention Strategies Among BRCA Mutation Carriers," Decision Analysis, INFORMS, vol. 14(3), pages 139-169, September.
    16. Oguzhan Alagoz & Jagpreet Chhatwal & Elizabeth S. Burnside, 2013. "Optimal Policies for Reducing Unnecessary Follow-Up Mammography Exams in Breast Cancer Diagnosis," Decision Analysis, INFORMS, vol. 10(3), pages 200-224, September.
    17. Malek Ebadi & Raha Akhavan-Tabatabaei, 2021. "Personalized Cotesting Policies for Cervical Cancer Screening: A POMDP Approach," Mathematics, MDPI, vol. 9(6), pages 1-20, March.
    18. Dan Andrei Iancu & Nikolaos Trichakis & Do Young Yoon, 2021. "Monitoring with Limited Information," Management Science, INFORMS, vol. 67(7), pages 4233-4251, July.
    19. Jue Wang, 2016. "Minimizing the false alarm rate in systems with transient abnormality," Naval Research Logistics (NRL), John Wiley & Sons, vol. 63(4), pages 320-334, June.
    20. Hessam Bavafa & Sergei Savin & Christian Terwiesch, 2021. "Customizing Primary Care Delivery Using E‐Visits," Production and Operations Management, Production and Operations Management Society, vol. 30(11), pages 4306-4327, November.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:inm:ormsom:v:14:y:2012:i:4:p:600-617. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Chris Asher (email available below). General contact details of provider: https://edirc.repec.org/data/inforea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.