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Optimizing the Finnish colorectal cancer population screening program with decision programming

Author

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  • Neuvonen, Lauri
  • Dillon, Mary
  • Vilkkumaa, Eeva
  • Salo, Ahti
  • Jäntti, Maija
  • Heinävaara, Sirpa

Abstract

In Finland, colorectal cancer (CRC) incidence rates have steadily increased over the last decades and as of 2020, CRC is the second most common cancer in both males and females. CRC is a crucial concern for the public health of Finland, highlighted by the recent implementation of a national population screening program. In this paper, we optimize the screening test positivity cut-off levels and the use of potential incentives for stratified populations to minimize cancer prevalence. The optimization results, computed with the novel Decision Programming approach for discrete multi-stage decision problems under uncertainty, show the optimal cut-off levels and uses of incentives for Finnish target groups subject to different constraints on colonoscopy capacity. The outcomes of these optimal strategies are estimated to determine the expected corresponding prevalences of CRC and required colonoscopies, and expected third-party costs. Finally, measures describing different equality perspectives are presented.

Suggested Citation

  • Neuvonen, Lauri & Dillon, Mary & Vilkkumaa, Eeva & Salo, Ahti & Jäntti, Maija & Heinävaara, Sirpa, 2025. "Optimizing the Finnish colorectal cancer population screening program with decision programming," European Journal of Operational Research, Elsevier, vol. 327(1), pages 295-308.
    • Handle: RePEc:eee:ejores:v:327:y:2025:i:1:p:295-308
    DOI: 10.1016/j.ejor.2025.04.022
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    References listed on IDEAS

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    1. Dimitris Bertsimas & John Silberholz & Thomas Trikalinos, 2018. "Optimal healthcare decision making under multiple mathematical models: application in prostate cancer screening," Health Care Management Science, Springer, vol. 21(1), pages 105-118, March.
    2. Fatih Safa Erenay & Oguzhan Alagoz & Ritesh Banerjee & Robert R. Cima, 2011. "Estimating the Unknown Parameters of the Natural History of Metachronous Colorectal Cancer Using Discrete-Event Simulation," Medical Decision Making, , vol. 31(4), pages 611-624, July.
    3. 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.
    4. Fatih Safa Erenay & Oguzhan Alagoz & Adnan Said, 2014. "Optimizing Colonoscopy Screening for Colorectal Cancer Prevention and Surveillance," Manufacturing & Service Operations Management, INFORMS, vol. 16(3), pages 381-400, July.
    5. repec:plo:pmed00:1002630 is not listed on IDEAS
    6. Marion S. Rauner & Walter J. Gutjahr & Kurt Heidenberger & Joachim Wagner & Joseph Pasia, 2010. "Dynamic Policy Modeling for Chronic Diseases: Metaheuristic-Based Identification of Pareto-Optimal Screening Strategies," Operations Research, INFORMS, vol. 58(5), pages 1269-1286, October.
    7. Neuvonen, Lauri & Wildemeersch, Matthias & Vilkkumaa, Eeva, 2023. "Supporting strategy selection in multiobjective decision problems under uncertainty and hidden requirements," European Journal of Operational Research, Elsevier, vol. 307(1), pages 279-293.
    8. Laura McLay & Christodoulos Foufoulides & Jason Merrick, 2010. "Using simulation-optimization to construct screening strategies for cervical cancer," Health Care Management Science, Springer, vol. 13(4), pages 294-318, December.
    9. Leonie Diedrich & Melanie Brinkmann & Maren Dreier & Siegbert Rossol & Wendelin Schramm & Christian Krauth, 2023. "Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models," PLOS ONE, Public Library of Science, vol. 18(8), pages 1-26, August.
    10. Daniel Underwood & Jingyu Zhang & Brian Denton & Nilay Shah & Brant Inman, 2012. "Simulation optimization of PSA-threshold based prostate cancer screening policies," Health Care Management Science, Springer, vol. 15(4), pages 293-309, December.
    11. Evrim Didem Güneş & Egemen Lerzan Örmeci & Derya Kunduzcu, 2015. "Preventing and Diagnosing Colorectal Cancer with a Limited Colonoscopy Resource," Production and Operations Management, Production and Operations Management Society, vol. 24(1), pages 1-20, January.
    12. Mucahit Cevik & Turgay Ayer & Oguzhan Alagoz & Brian L. Sprague, 2018. "Analysis of Mammography Screening Policies under Resource Constraints," Production and Operations Management, Production and Operations Management Society, vol. 27(5), pages 949-972, May.
    13. Holzmann, Tim & Smith, J.C., 2018. "Solving discrete multi-objective optimization problems using modified augmented weighted Tchebychev scalarizations," European Journal of Operational Research, Elsevier, vol. 271(2), pages 436-449.
    14. 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.
    15. Salo, Ahti & Andelmin, Juho & Oliveira, Fabricio, 2022. "Decision programming for mixed-integer multi-stage optimization under uncertainty," European Journal of Operational Research, Elsevier, vol. 299(2), pages 550-565.
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