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Badizadegan K, Kalkowska DA, Thompson KM. Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame. Med Decis Making 2023; 43:850-862. [PMID: 37577803 PMCID: PMC10680042 DOI: 10.1177/0272989x231191127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Polio antiviral drugs (PAVDs) may provide a critical tool in the eradication endgame by stopping poliovirus infections in immunodeficient individuals who may not clear the virus without therapeutic intervention. Although prolonged/chronic poliovirus excreters are rare, they represent a source of poliovirus reintroduction into the general population. Prior studies that assumed the successful cessation of all oral poliovirus vaccine (OPV) use estimated the potential upper bound of the incremental net benefits (INBs) of resource investments in research and development of PAVDs. However, delays in polio eradication, OPV cessation, and the development of PAVDs necessitate an updated economic analysis to reevaluate the costs and benefits of further investments in PAVDs. METHODS Using a global integrated model of polio transmission, immunity, vaccine dynamics, risks, and economics, we explore the risks of reintroduction of polio transmission due to immunodeficiency-related vaccine-derived poliovirus (iVDPV) excreters and reevaluate the upper bound of the INBs of PAVDs. RESULTS Under the current conditions, for which the use of OPV will likely continue for the foreseeable future, even with successful eradication of type 1 wild poliovirus by the end of 2023 and continued use of Sabin OPV for outbreak response, we estimate an upper bound INB of 60 million US$2019. With >100 million US$2019 already invested in PAVD development and with the introduction of novel OPVs that are less likely to revert to neurovirulence, our analysis suggests the expected INBs of PAVDs would not offset their costs. CONCLUSIONS While PAVDs could play an important role in the polio endgame, their expected economic benefits drop with ongoing OPV use and poliovirus transmissions. However, stakeholders may pursue the development of PAVDs as a desired product regardless of their economic benefits.HighlightsWhile polio antiviral drugs could play an important role in the polio endgame, their expected economic benefits continue to drop with delays in polio eradication and the continued use of oral poliovirus vaccines.The incremental net benefits of investments in polio antiviral drug development and screening for immunodeficiency-related circulating polioviruses are small.Limited global resources are better spent on increasing global population immunity to polioviruses to stop and prevent poliovirus transmission.
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Reza HM, Sultana F, Bari R, Cole J, Baqui AH. Local distribution infrastructure and robust vaccine manufacturing facilities in LMICs should be prioritised to tackle ongoing and future pandemic risk. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 11:100158. [PMID: 37384365 PMCID: PMC10305885 DOI: 10.1016/j.lansea.2023.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/18/2022] [Accepted: 01/19/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Farhana Sultana
- Department of Political Science and Sociology, North South University, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Razmin Bari
- College of Arts & Sciences, University of North Carolina at Chapel Hill, NC, USA
| | - Jennifer Cole
- Department of Health Studies, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
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Thompson KM, Kalkowska DA, Badizadegan K. Looking back at prospective modeling of outbreak response strategies for managing global type 2 oral poliovirus vaccine (OPV2) cessation. Front Public Health 2023; 11:1098419. [PMID: 37033033 PMCID: PMC10080024 DOI: 10.3389/fpubh.2023.1098419] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Detection of poliovirus transmission and ongoing oral poliovirus vaccine (OPV) use continue to delay poliomyelitis eradication. In 2016, the Global Polio Eradication Initiative (GPEI) coordinated global cessation of type 2 OPV (OPV2) for preventive immunization and limited its use to emergency outbreak response. In 2019, GPEI partners requested restart of some Sabin OPV2 production and also accelerated the development of a genetically modified novel OPV2 vaccine (nOPV2) that promised greater genetic stability than monovalent Sabin OPV2 (mOPV2). Methods We reviewed integrated risk, economic, and global poliovirus transmission modeling performed before OPV2 cessation, which recommended multiple risk management strategies to increase the chances of successfully ending all transmission of type 2 live polioviruses. Following OPV2 cessation, strategies implemented by countries and the GPEI deviated from model recommended risk management strategies. Complementing other modeling that explores prospective outbreak response options for improving outcomes for the current polio endgame trajectory, in this study we roll back the clock to 2017 and explore counterfactual trajectories that the polio endgame could have followed if GPEI had: (1) managed risks differently after OPV2 cessation and/or (2) developed nOPV2 before and used it exclusively for outbreak response after OPV2 cessation. Results The implementation of the 2016 model-based recommended outbreak response strategies could have ended (and could still substantially improve the probability of ending) type 2 poliovirus transmission. Outbreak response performance observed since 2016 would not have been expected to achieve OPV2 cessation with high confidence, even with the availability of nOPV2 prior to the 2016 OPV2 cessation. Discussion As implemented, the 2016 OPV2 cessation failed to stop type 2 transmission. While nOPV2 offers benefits of lower risk of seeding additional outbreaks, its reduced secondary spread relative to mOPV2 may imply relatively higher coverage needed for nOPV2 than mOPV2 to stop outbreaks.
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Van Oorschot KE, Van Wassenhove LN, Jahre M. Collaboration-competition dilemma in flattening the COVID-19 curve. PRODUCTION AND OPERATIONS MANAGEMENT 2022; 32:POMS13709. [PMID: 35601840 PMCID: PMC9115479 DOI: 10.1111/poms.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
Testing for COVID-19 is a key intervention that supports tracking and isolation to prevent further infections. However, diagnostic tests are a scarce and finite resource, so abundance in one country can quickly lead to shortages in others, creating a competitive landscape. Countries experience peaks in infections at different times, meaning that the need for diagnostic tests also peaks at different moments. This phase lag implies opportunities for a more collaborative approach, although countries might also worry about the risks of future shortages if they help others by reallocating their excess inventory of diagnostic tests. This article features a simulation model that connects three subsystems: COVID-19 transmission, the diagnostic test supply chain, and public policy interventions aimed at flattening the infection curve. This integrated system approach clarifies that, for public policies, there is a time to be risk-averse and a time for risk-taking, reflecting the different phases of the pandemic (contagion vs. recovery) and the dominant dynamic behavior that occurs in these phases (reinforcing vs. balancing). In the contagion phase, policymakers cannot afford to reject extra diagnostic tests and should take what they can get, in line with a competitive mindset. In the recovery phase, policymakers can afford to give away excess inventory to other countries in need (one-sided collaboration). When a country switches between taking and giving, in a form of two-sided collaboration, it can flatten the curve, not only for itself but also for others.
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Affiliation(s)
- Kim E. Van Oorschot
- Department of Accounting and Operations ManagementBI Norwegian Business SchoolOsloNorway
| | | | - Marianne Jahre
- Department of Accounting and Operations ManagementBI Norwegian Business SchoolOsloNorway
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Tools for Supporting the MCH Workforce in Addressing Complex Challenges: A Scoping Review of System Dynamics Modeling in Maternal and Child Health. Matern Child Health J 2022; 26:176-203. [PMID: 35188621 PMCID: PMC9482604 DOI: 10.1007/s10995-022-03376-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objectives System Dynamics (SD) is a promising decision support modeling approach for growing shared understanding of complex maternal and child health (MCH) trends. We sought to inventory published applications of SD to MCH topics and introduce the MCH workforce to these approaches through examples to support further iteration and use. Methods We conducted a systematic search (1958–2018) for applications of SD to MCH topics and characterized identified articles, following PRISMA guidelines. Pairs of experts abstracted information on SD approach and MCH relevance. Results We identified 101 articles describing applications of SD to MCH topics. Approach: 27 articles present qualitative diagrams, 10 introduce concept models that begin to quantify dynamics, and 67 present more fully tested/analyzed models. Purpose: The most common purposes described were to increase understanding (n = 55) and support strategic planning (n = 26). While the majority of studies (n = 53) did not involve stakeholders, 40 included what we considered to be a high level of stakeholder engagement – a strength of SD for MCH. Topics: The two Healthy People 2020 topics addressed most frequently were early and middle childhood (n = 30) and access to health services (n = 26). The most commonly addressed SDG goals were “End disease epidemics” (n = 26) and “End preventable deaths” (n = 26). Conclusions for Practice While several excellent examples of the application of SD in MCH were found, SD is still underutilized in MCH. Because SD is particularly well-suited to studying and addressing complex challenges with stakeholders, its expanded use by the MCH workforce could inform an understanding of contemporary MCH challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03376-8.
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Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
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Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
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An evaluation of Hamiltonian Monte Carlo performance to calibrate age-structured compartmental SEIR models to incidence data. Epidemics 2020; 33:100415. [PMID: 33212347 DOI: 10.1016/j.epidem.2020.100415] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
Hamiltonian Monte Carlo (HMC) is a Markov chain Monte Carlo method to estimate unknown quantities through sample generation from a target distribution for which an analytical solution is difficult. The strength of this method lies in its geometrical foundations, which render it efficient for traversing high-dimensional spaces. First, this paper analyses the performance of HMC in calibrating five variants of inputs to an age-structured SEIR model. Four of these variants are related to restriction assumptions that modellers devise to handle high-dimensional parameter spaces. The other one corresponds to the unrestricted symmetric variant. To provide a robust analysis, we compare HMC's performance to that of the Nelder-Mead algorithm (NMS), a common method for non-linear optimisation. Furthermore, the calibration is performed on synthetic data in order to avoid confounding effects from errors in model selection. Then, we explore the variation in the method's performance due to changes in the scale of the problem. Finally, we fit an SEIR model to real data. In all the experiments, the results show that HMC approximates both the synthetic and real data accurately, and provides reliable estimates for the basic reproduction number and the age-dependent transmission rates. HMC's performance is robust in the presence of underreported incidences and high-dimensional complexity. This study suggests that stringent assumptions on age-dependent transmission rates can be lifted in favour of more realistic representations. The supplementary section presents the full set of results.
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Thompson KM, Kalkowska DA. Review of poliovirus modeling performed from 2000 to 2019 to support global polio eradication. Expert Rev Vaccines 2020; 19:661-686. [PMID: 32741232 PMCID: PMC7497282 DOI: 10.1080/14760584.2020.1791093] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Over the last 20 years (2000-2019) the partners of the Global Polio Eradication Initiative (GPEI) invested in the development and application of mathematical models of poliovirus transmission as well as economics, policy, and risk analyses of polio endgame risk management options, including policies related to poliovirus vaccine use during the polio endgame. AREAS COVERED This review provides a historical record of the polio studies published by the three modeling groups that primarily performed the bulk of this work. This review also systematically evaluates the polio transmission and health economic modeling papers published in English in peer-reviewed journals from 2000 to 2019, highlights differences in approaches and methods, shows the geographic coverage of the transmission modeling performed, identified common themes, and discusses instances of similar or conflicting insights or recommendations. EXPERT OPINION Polio modeling performed during the last 20 years substantially impacted polio vaccine choices, immunization policies, and the polio eradication pathway. As the polio endgame continues, national preferences for polio vaccine formulations and immunization strategies will likely continue to change. Future modeling will likely provide important insights about their cost-effectiveness and their relative benefits with respect to controlling polio and potentially achieving and maintaining eradication.
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Ghaffarzadegan N, Rahmandad H. Simulation-based estimation of the early spread of COVID-19 in Iran: actual versus confirmed cases. SYSTEM DYNAMICS REVIEW 2020; 36:101-129. [PMID: 32834468 PMCID: PMC7361282 DOI: 10.1002/sdr.1655] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 05/08/2023]
Abstract
Understanding the state of the COVID-19 pandemic relies on infection and mortality data. Yet official data may underestimate the actual cases due to limited symptoms and testing capacity. We offer a simulation-based approach which combines various sources of data to estimate the magnitude of outbreak. Early in the epidemic we applied the method to Iran's case, an epicenter of the pandemic in winter 2020. Estimates using data up to March 20th, 2020, point to 916,000 (90% UI: 508 K, 1.5 M) cumulative cases and 15,485 (90% UI: 8.4 K, 25.8 K) total deaths, numbers an order of magnitude higher than official statistics. Our projections suggest that absent strong sustaining of contact reductions the epidemic may resurface. We also use data and studies from the succeeding months to reflect on the quality of original estimates. Our proposed approach can be used for similar cases elsewhere to provide a more accurate, early, estimate of outbreak state. © 2020 System Dynamics Society.
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10
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Brunton LA, Desbois AP, Garza M, Wieland B, Mohan CV, Häsler B, Tam CC, Le PNT, Phuong NT, Van PT, Nguyen-Viet H, Eltholth MM, Pham DK, Duc PP, Linh NT, Rich KM, Mateus ALP, Hoque MA, Ahad A, Khan MNA, Adams A, Guitian J. Identifying hotspots for antibiotic resistance emergence and selection, and elucidating pathways to human exposure: Application of a systems-thinking approach to aquaculture systems. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 687:1344-1356. [PMID: 31412468 PMCID: PMC6905156 DOI: 10.1016/j.scitotenv.2019.06.134] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 05/15/2023]
Abstract
Aquaculture systems are highly complex, dynamic and interconnected systems influenced by environmental, biological, cultural, socio-economic and human behavioural factors. Intensification of aquaculture production is likely to drive indiscriminate use of antibiotics to treat or prevent disease and increase productivity, often to compensate for management and husbandry deficiencies. Surveillance or monitoring of antibiotic usage (ABU) and antibiotic resistance (ABR) is often lacking or absent. Consequently, there are knowledge gaps for the risk of ABR emergence and human exposure to ABR in these systems and the wider environment. The aim of this study was to use a systems-thinking approach to map two aquaculture systems in Vietnam - striped catfish and white-leg shrimp - to identify hotspots for emergence and selection of resistance, and human exposure to antibiotics and antibiotic-resistant bacteria. System mapping was conducted by stakeholders at an interdisciplinary workshop in Hanoi, Vietnam during January 2018, and the maps generated were refined until consensus. Thereafter, literature was reviewed to complement and cross-reference information and to validate the final maps. The maps and component interactions with the environment revealed the grow-out phase, where juveniles are cultured to harvest size, to be a key hotspot for emergence of ABR in both systems due to direct and indirect ABU, exposure to water contaminated with antibiotics and antibiotic-resistant bacteria, and duration of this stage. The pathways for human exposure to antibiotics and ABR were characterised as: occupational (on-farm and at different handling points along the value chain), through consumption (bacterial contamination and residues) and by environmental routes. By using systems thinking and mapping by stakeholders to identify hotspots we demonstrate the applicability of an integrated, interdisciplinary approach to characterising ABU in aquaculture. This work provides a foundation to quantify risks at different points, understand interactions between components, and identify stakeholders who can lead and implement change.
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Affiliation(s)
- Lucy A Brunton
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK.
| | - Andrew P Desbois
- Institute of Aquaculture, Pathfoot Building, University of Stirling, Stirling FK9 4LA, UK.
| | - Maria Garza
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK.
| | - Barbara Wieland
- International Livestock Research Institute, P.O. Box 5689, Addis Ababa, Ethiopia.
| | | | - Barbara Häsler
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK.
| | - Clarence C Tam
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; National University of Singapore, National University Health System, 1E Kent Ridge Rd, Singapore.
| | - Phuc Nguyen Thien Le
- School of Biotechnology, International University - Vietnam National University HCMC, Đông Hoà, Thủ Đức, Ho Chi Minh City, Viet Nam
| | - Nguyen Thanh Phuong
- College of Aquaculture and Fisheries, Can Tho University, Campus 2, 3/2 street, Xuân Khánh, Ninh Kiều, Cần Thơ, Viet Nam.
| | - Phan Thi Van
- Research Institute for Aquaculture No. 1, Đình Bảng, Từ Sơn, Bắc Ninh, Viet Nam.
| | - Hung Nguyen-Viet
- International Livestock Research Institute, 298 Kim Ma Street, Ba Dinh District, Hanoi, Viet Nam.
| | - Mahmoud M Eltholth
- Institute of Aquaculture, Pathfoot Building, University of Stirling, Stirling FK9 4LA, UK; Faculty of Veterinary Medicine, Kafrelsheikh University, El Guish St., Kafr El Sheikh, Egypt
| | - Dang Kim Pham
- Vietnam National University of Agriculture, Trau Quy, Gia Lam, Hanoi, Viet Nam.
| | - Phuc Pham Duc
- Hanoi University of Public Health, 1A Đức Thắng, Phường Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Viet Nam.
| | - Nguyen Tuong Linh
- School of Biotechnology, International University - Vietnam National University HCMC, Đông Hoà, Thủ Đức, Ho Chi Minh City, Viet Nam
| | - Karl M Rich
- International Livestock Research Institute, 298 Kim Ma Street, Ba Dinh District, Hanoi, Viet Nam.
| | - Ana L P Mateus
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK.
| | - Md Ahasanul Hoque
- Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chittagong, Bangladesh.
| | - Abdul Ahad
- Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chittagong, Bangladesh.
| | - Mohammed Nurul Absar Khan
- Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chittagong, Bangladesh
| | - Alexandra Adams
- Institute of Aquaculture, Pathfoot Building, University of Stirling, Stirling FK9 4LA, UK.
| | - Javier Guitian
- Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK.
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Namin AT, Jalali MS, Vahdat V, Bedair HS, O'Connor MI, Kamarthi S, Isaacs JA. Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:423-430. [PMID: 30975393 DOI: 10.1016/j.jval.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the impact of insurance coverage on the adoption of customized individually made (CIM) knee implants and to compare patient outcomes and cost effectiveness of off-the-shelf and CIM implants. METHODS A system dynamics simulation model was developed to study adoption dynamics of CIM and meet the research objectives. The model reproduced the historical data on primary and revision knee replacement implants obtained from the literature and the Nationwide Inpatient Sample. Then the dynamics of adoption of CIM implants were simulated from 2018 to 2026. The rate of 90-day readmission, 3-year revision surgery, recovery period, time savings in operating rooms, and the associated cost within 3 years of primary knee replacement implants were used as performance metrics. RESULTS The simulation results indicate that by 2026, an adoption rate of 90% for CIM implants can reduce the number of readmissions and revision surgeries by 62% and 39%, respectively, and can save hospitals and surgeons 6% on procedure time and cut down cumulative healthcare costs by approximately $38 billion. CONCLUSIONS CIM implants have the potential to deliver high-quality care while decreasing overall healthcare costs, but their adoption requires the expansion of current insurance coverage. This work presents the first systematic study to understand the dynamics of adoption of CIM knee implants and instrumentation. More broadly, the current modeling approach and systems thinking perspective could be used to consider the adoption of any emerging customized therapies for personalized medicine.
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MESH Headings
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/instrumentation
- Computer Simulation
- Cost Savings
- Cost-Benefit Analysis
- Databases, Factual
- Health Care Costs
- Hospital Costs
- Humans
- Insurance Coverage/economics
- Insurance, Health/economics
- Knee Prosthesis/economics
- Models, Economic
- Operative Time
- Outcome and Process Assessment, Health Care/economics
- Patient Readmission/economics
- Prosthesis Design/economics
- Reoperation/economics
- Time Factors
- Treatment Outcome
- United States
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Affiliation(s)
- Amir T Namin
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA; Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Vahab Vahdat
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA; MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary I O'Connor
- Center for Musculoskeletal Care, Yale School of Medicine, New Haven, CT, USA
| | - Sagar Kamarthi
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Jacqueline A Isaacs
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
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