Screening for a Chronic Disease: A Multiple Stage Duration Model with Partial Observability

This study develops a discrete multiple state duration model for screen- ing a chronic disease that allows for duration dependence, unmeasured heterogeneity, partial observability of the state and endogenous treat- ment. We study whether screening for diabetes is e¤ective in delaying progression of complications of the lower extremities. Our results show that early diagnoses of diabetes reduces the probabilities of transitioning to a worse disease stage, death or amputation. In particular, decreasing the time screening for the onset of diabetes from every four years to once a year after age 65 saves: 54 lives, 10 amputations, and 89 lower extremity complications of 10,000 individuals by age 80.