Queue hurdle Coxian phase-type model for two-stage process of population-based cancer screening

Hsiao Hsuan Jen, Chen Yang Hsu, Amy Ming Fang Yen, Han Mo Chiu, Hsiu Hsi Chen

Research output: Contribution to journalArticlepeer-review


The quality assurance of two-stage population-based cancer screening program is determined by arrival rate (attending screening), positive rate (determined by the criteria of screening test), the compliance and the waiting time (WT) for confirmatory diagnosis in those screened as positive. These parameters were correlated between the process of screening procedures and the effectiveness of screening program. To capture such an inter-dependence of these parameters and quantify the effectiveness of program, we proposed a Queue hurdle Coxian phase-type (QH-CPH) model to estimate the arrival rate of screenees with the Poisson Queue process and the compliance rate of confirmatory diagnosis with the hurdle model, and also to identify the hidden states of WT that is affected by the capacity of health care and relevant covariates (such as demographic features and geographic areas) with the Coxian phase-type (CPH) process. We applied the proposed QH-CPH model to Taiwanese nationwide colorectal cancer screening program data for estimating the arrival rate and the probability of not complying with colonoscopy and classifying the compliers into two hidden states, short-waiting phase and long-waiting phase for colonoscopy. Significant covariates responsible for three processes were also identified by using the proportional hazards regression forms. A simulation study was further performed to assess the joint effect of these parameters on WT through a series of scenarios. The proposed QH-CPH model can provide an insight into the optimal and the practical design on population-based cancer screening for health policy-makers given the limited health care resources and capacity.

Original languageEnglish
JournalStatistical Methods and Applications
Publication statusAccepted/In press - 2021


  • Coxian phase-type distribution
  • Poisson hurdle model
  • Queue model
  • Waiting time

ASJC Scopus subject areas

  • Statistics and Probability
  • Statistics, Probability and Uncertainty


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