Public Health Resources



Brad J. Biggerstaff

Date of this Version



Statistics in Medicine. 2021;40:3887–3888.

DOI: 10.1002/sim.8989


This article is a U.S. Government work and is in the public domain in the USA.


I congratulate the authors on an interesting, instructive, and timely paper. Certainly, including the testing for SARS-CoV-2 example in a paper on a topic—group testing—of wide interest during the current COVID-19 pandemic emphasizes the relevance of the topic in public health and diagnostic medicine generally. But the thoughtful inclusion of the remaining examples—HIV, HPV, and cancer biomarker detection—illustrates that the issues considered are important even in less urgent times. In this note of discussion I will comment on two particular aspects in the paper that I found particularly informative, and then I will comment on two other, related areas that I believe the conclusions inform. I found the direct use of explicit constraints on Se(k) and Sp(k) in design optimization natural and, as the authors say, “very easy to interpret and explain to non-statisticians.” Incorporating these constraints at the outset of design optimization should have the further, philosophical advantage that consideration of and specification of these must (ideally) be made by subject matter experts before cost evaluations are undertaken, so that screening and diagnostic needs rather than cost constraints do not unduly drive (or result in inadvertant or active manipulation of) performance requirements.