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Medical Decision Making
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Use of the Hazard Rate to Schedule Follow-Up Exams Efficiently

An Optimization Approach to Patient Management

Andrew J. Dwyer, M.D.

Judith M. S. Prewitt, Ph.D.

J.G. Ecker, Ph.D.

J. Plunkett, M. S.

The problem of surveillance for metastasis in a cancer patient is modeled as an allo cation problem. The hazard rate of metastasis appearing determines the efficient scheduling of follow-up exams. An optimal schedule of follow-up exams is shown to be dependent on the hazard rate, K, and D. K relates the cost of testing to the benefit of early detection. It diminishes as benefit increases or cost diminishes. D is the time by which a metastasis' detection by testing precedes its clinical presentation. Hence it is a direct measure of the effectiveness of testing. The optimal testing frequency = (hazard rate/2K)1/2. Testing may be stopped when the hazard rate drops below 2K/ D2. Tests need never be routinely scheduled if the intervals between tests exceed D in length. (Med Decis Making 3:229-244, 1983)

Medical Decision Making, Vol. 3, No. 2, 229-244 (1983)
DOI: 10.1177/0272989X8300300211
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