Suchergebnisse

AbstractState‐level newborn screening allows for early treatment of genetic disorders, which can substantially improve health outcomes for newborns. As the cost of genetic testing decreases, it is becoming an essential part of newborn screening. A genetic disorder can be caused by many mutation variants; therefore, an important decision is to determine which variants to search for (ie, thepaneldesign), under a testing budget. The frequency of variants that cause a disorder and the incidence of the disorder vary by racial/ethnic group. Consequently, it is important to consider equity issues in panel design, so as to reduce disparities among different groups. We study the panel design problem using cystic fibrosis (CF) as a model disorder, considering the trade‐offs between equity and accuracy, under a limited budget. Most states use a genetic test in their CF screening protocol, but panel designs vary, and, due to cost, no state's panel includes all CF‐causing variants. We develop models that design equitable genetic testing panels, and compare them with panels that maximize sensitivity in the general population. Our case study, based on realistic CF data, highlights the value of equitable panels and provides important insight for newborn screening practices.

AbstractTesting provides essential information for managing infectious disease outbreaks, such as the COVID‐19 pandemic. When testing resources are scarce, an important managerial decision is who to test. This decision is compounded by the fact that potential testing subjects are heterogeneous in multiple dimensions that are important to consider, including their likelihood of being disease‐positive, and how much potential harm would be averted through testing and the subsequent interventions. To increase testing coverage, pooled testing can be utilized, but this comes at a cost of increased false‐negatives when the test is imperfect. Then, the decision problem is to partition the heterogeneous testing population into three mutually exclusive sets: those to be individually tested, those to be pool tested, and those not to be tested. Additionally, the subjects to be pool tested must be further partitioned into testing pools, potentially containing different numbers of subjects. The objectives include the minimization of harm (through detection and mitigation) or maximization of testing coverage. We develop data‐driven optimization models and algorithms to design pooled testing strategies, and show, via a COVID‐19 contact tracing case study, that the proposed testing strategies can substantially outperform the current practice used for COVID‐19 contact tracing (individually testing those contacts with symptoms). Our results demonstrate the substantial benefits of optimizing the testing design, while considering the multiple dimensions of population heterogeneity and the limited testing capacity.