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报告题目: Optimizing Initial Screening for Colorectal Cancer Detection with Adherence Behavior

报告内容: Two-stage screening programs are widely adopted for early colorectal cancer (CRC) detection, where 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—the selection of cutoffs for reporting test outcomes—to balance the trade-off between screening effectiveness (i.e., CRC and polyp detection) and efficiency (i.e., colonoscopy costs), incorporating the fact that not all individuals follow up with a colonoscopy after receiving positive outcomes. We integrate the Bayesian persuasion framework with information avoidance to model this problem and apply it to Singapore's CRC screening program design. We calibrate the model using various sources of data, including a nationwide survey with 3,920 responses in Singapore. We show that under certain conditions, using a single cutoff is optimal for maximizing follow-up, while showing exact biomarker readings is optimal for maximizing effectiveness. Our results suggest that, compared to the current practice, raising the cutoff to our recommended level of 39 µg/g can detect 20.83% more CRC and polyp incidences, reduce 26.98% colonoscopies, and lower the lifetime risk of CRC by 11.03%. This could reduce public healthcare expenditure by S$19.93 million and individual spending by S$11.96 million on average in screening costs. The current practice of using lower cutoffs to achieve high sensitivity can result in an excessive number of unnecessary colonoscopies and low adherence rates.

报告人简介：Zhichao Zheng is an Associate Professor of Operations Management at the Singapore Management University. His main research interests lie in data analytics and optimization for healthcare operations management and medical decision-making. He also applies his research in sharing economics, supply chain risk management, etc. His research has appeared in Operations Research, Management Science, and Manufacturing & Service Operations Management, among others. He received his BS (First Class Honors) in Applied Mathematics from the National University of Singapore in 2009 and Ph.D. in Management from the Department of Decision Sciences (renamed to Department of Analytics & Operations) at the National University of Singapore in 2013.