Personalized cotesting policies for cervical cancer screening: A pomdp approach

Abstract

Screening for cervical cancer is a critical policy that requires clinical and managerial vigilance because of its serious health consequences. Recently the practice of conducting simultaneous tests of cytology and Human Papillomavirus (HPV)-DNA testing (known as cotesting) has been included in the public health policies and guidelines with a fixed frequency. On the other hand, personalizing medical interventions by incorporating patient characteristics into the decision making process has gained considerable attention in recent years. We develop a personalized partially observable Markov decision process (POMDP) model for cervical cancer screening decisions by cotesting. In addition to the merits offered by the guidelines, by availing the possibility of including patient-specific risks and other attributes, our POMDP model provides a patient-tailored screening plan. Our results show that the policy generated by the POMDP model outperforms the static guidelines in terms of quality-adjusted life years (QALY) gain, while performing comparatively equal in lifetime risk reduction.