Planning and Evaluation of Screening
[ EL022 ]

This course focuses on the design and the evaluation of health care programmes for the early detection of disease or screening. Screening takes place in a population without symptoms of the disease. The screening test characteristics have consequences for the favourable (improvement of prognosis by early detection, life years saved and deaths prevented) and unfavourable (overdiagnosis, unnecessary treatments) effects of screening.

There are a number of designs for the assessment of the effectiveness of screening, such as randomized-controlled trials, observational prospective studies and case control studies. The pros and cons of each of these designs will be discussed. Evaluation methodologies, such as cost-effectiveness, cost-utility and technology assessment will be explained, including the concepts of quality adjustment of life years and of time preference. Detailed case studies include cervical, breast and prostate cancer screening, genetic screening, youth health care and screening for tuberculosis, e.g. for high risk groups. Several computer aids for the evaluation of screening are presented.

Only the afternoon sessions require physical presence.

At the end of this course, one should have obtained understanding of and insight in:

1. determinants for effectiveness;

2. measures for effectiveness of screening, levels of evidence for effectiveness, trial designs, implementation of trials;

3. possible negative side effects, determinants of side effects;

4. measurement of quality of life, quality adjustment of life years;

5. the use of models for data analysis (describing the underlying natural history of the disease) and for predictions;

6. definition of high risk groups;

7. cost effectiveness analysis, optimization of strategies, time preference.

Attendance, Assignment(s)

T.B.A.