Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa.
Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa.
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DOI：
10.1093/heapol/czab155
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发表时间：
2022-03-04
影响因子：
3.2
通讯作者：
Vassall A
中科院分区：
文献类型：
--
作者：
Bozzani FM;Diaconu K;Gomez GB;Karat AS;Kielmann K;Grant AD;Vassall A
人们日益认识到，卫生系统的制约因素是对基于模型的疾病控制干预措施分析的重要补充，因为它们影响到可实现的影响和规模。与放松限制和达到预期覆盖范围的干预措施一起实施的扶持活动可能会产生额外成本，在确定优先事项的决定中应考虑这一点。我们探讨使用组模型建设，参与式系统动力学建模技术，从主要利益相关者的限制，适用于结核病感染的预防和控制过程中，在南非的初级卫生保健诊所的信息。这一信息被用来设计可行的干预措施，包括放松现有限制的必要手段。然后，使用已发表文献和当地供应商的投入价格和数量，计算了夸祖鲁-纳塔尔两个诊所的干预和促成成本。在拟议的干预措施中，最便宜的是改造建筑物以改善通风（每年1，644美元），其次是最大限度地利用社区站点为接受抗逆转录病毒治疗的稳定患者收集药物（抗逆转录病毒疗法; 3，753美元），并采用预约制度以减少拥挤（9，302美元）。确定的推动因素包括加强工作人员培训、监督和患者参与活动，以支持行为改变和地方自主权。利益攸关方确定的若干促进因素，如获得建筑许可或改善各级卫生系统之间的信息流动，不适合进行成本计算。尽管有这种局限性，一种植根于系统动力学模型的成本计算方法可以成功地应用于经济评估，以更准确地估计干预方案的“真实的世界”机会成本。将这一方法应用于不同类型的干预措施（如新的预防技术或诊断）的进一步实证研究，可以根据对使能手段所需投资的规模，确定在具体情况下不具成本效益的干预措施。
Health system constraints are increasingly recognized as an important addition to model-based analyses of disease control interventions, as they affect achievable impact and scale. Enabling activities implemented alongside interventions to relax constraints and reach the intended coverage may incur additional costs, which should be considered in priority setting decisions. We explore the use of group model building, a participatory system dynamics modelling technique, for eliciting information from key stakeholders on the constraints that apply to tuberculosis infection prevention and control processes within primary healthcare clinics in South Africa. This information was used to design feasible interventions, including the necessary enablers to relax existing constraints. Intervention and enabler costs were then calculated at two clinics in KwaZulu-Natal using input prices and quantities from the published literature and local suppliers. Among the proposed interventions, the most inexpensive was retrofitting buildings to improve ventilation (US$1644 per year), followed by maximizing the use of community sites for medication collection among stable patients on antiretroviral therapy (ART; US$3753) and introducing appointments systems to reduce crowding (US$9302). Enablers identified included enhanced staff training, supervision and patient engagement activities to support behaviour change and local ownership. Several of the enablers identified by the stakeholders, such as obtaining building permissions or improving information flow between levels of the health systems, were not amenable to costing. Despite this limitation, an approach to costing rooted in system dynamics modelling can be successfully applied in economic evaluations to more accurately estimate the ‘real world’ opportunity cost of intervention options. Further empirical research applying this approach to different intervention types (e.g. new preventive technologies or diagnostics) may identify interventions that are not cost-effective in specific contexts based on the size of the required investment in enablers.
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影响因子：
8.1
作者：
Kielmann, Karina;Karat, Aaron S.;Grant, Alison D.
通讯作者：
Grant, Alison D.
影响因子：
3.7
作者：
Claassens MM;van Schalkwyk C;du Toit E;Roest E;Lombard CJ;Enarson DA;Beyers N;Borgdorff MW
通讯作者：
Borgdorff MW
影响因子：
6.7
作者：
Islam, M. Saiful;Chughtai, Abrar Ahmad;Seale, Holly
通讯作者：
Seale, Holly
DOI：
10.5588/ijtld.19.0410
发表时间：
2020-04-01
影响因子：
4
作者：
McCreesh, N.;Grant, A. D.;White, R. G.
通讯作者：
White, R. G.
DOI：
10.1186/s13012-016-0392-8
发表时间：
2016-03-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Iwelunmor J;Blackstone S;Veira D;Nwaozuru U;Airhihenbuwa C;Munodawafa D;Kalipeni E;Jutal A;Shelley D;Ogedegebe G
通讯作者：
Ogedegebe G