Screening Programs and Health Care Decision Making: Utility, Disutility and Inertia

The reach and influence of screening programs are considered important for public health in many countries. Screening comprises tests offered to apparently ‘healthy’ and certainly asymptomatic individuals, identifying those deemed to need further investigations or treatment. The potential for overestimating the benefits of screening is well documented but the quantification of the associated  harms, often referred to as disutility, has been largely overlooked in model based economic evaluations. This presentation will focus on these issues in the context two contrasting case studies of screening interventions and their impact on policy in the UK - Pulse oximetry as a screening test for critical congenital heart defects in newborn infants and breast cancer screening. It will discuss methods and challenges for quantifying the harms and report an empirical study explicitly focused on quantifying the utility and dis-utility associated with screening for one of these case studies.  Finally, it will reflect upon the risk of misplaced policy decisions unless the decision process includes the appropriate utilities and dis-utilities associated with screening.

This seminar is co-sponsored by the Centre for Clinical Epidemiology and Evaluation, the UBC Centre for Health Services and Policy Research and ARCC.