550.

111, Case Study: Testing for diseases

You should work through this problem on the implications of testing for a disease. This is a problem that
impacts public health policymaking at multiple levels. Please neatly write your answer to each of the
questions below, and submit your write-up along with your homework on Friday, September
30, 2016.
Problem 1. The prevalence of a disease is the probability of currently having the disease; it is obtained
by dividing the number of people who currently have the disease by the total number of people in the population. The sensitivity of a screening test is the probability that a sick person will be diagnosed by the
test as sick. (Usually, a diagnosis of illness involves a so-called positive test result.) The specificity of a
screening test is the probability that a healthy person will be diagnosed by the test as healthy. Finally, the
positive predictive value (PPV) of a test is the probability that a person who tests positive on the test (i.e.
is diagnosed by the test as being sick) is actually sick, and the negative predictive value is the probability
that a person who test negative on the test (i.e. is diagnosed by the test as being healthy) is actually healthy.
Suppose that the prevalence of a certain disease is 0.01. In a diagnostic test, a healthy person has a 0.01
chance of being falsely diagnosed as having the disease, and a sick person has a 0.01 chance of being falsely
diagnosed as not having the disease.
(a) Draw a tree diagram to represent this situation. Mark the appropriate probabilities at each node of the
tree. Remember that the probability at each node are conditional probabilities, conditional on reaching
that node.

(b) What is the sensitivity and specificity of this test?

(c) What is the probability a test result is positive?

(d) What is the probability of having the disease but being diagnosed as healthy?

(e) What is the probability that the person is correctly diagnosed and is healthy?

(f) Suppose the test result is positive. What is the probability the person actually has the disease? What
does this imply about the positive predictive value of the test?

(g) Is your answer to the last part surprising? Give a verbal explanation of why the answer makes sense.

(h) Repeat part (f)i.e. calculate the probability that, given that a person tests positive, he or she is
actually sickfor the case when the disease prevalence is 25%, 50%, and 80%, respectively. Does the
answer change? Why? Again, give a verbal description of why the answer changes.

(i) Suppose you want the probability in part (f) to be at least some number p. Let x be the fraction of
people who have the disease. How large must x be in order for the positive predictive value to be at
least p?

(j) The probability of having the disease, given that a test result is positive, is called a posterior probability. Why does this term seem reasonable?

(k) How can the prevalence of a disease be estimated?