Reda M. Lebcir

High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis: system dynamics simulation

We used a system dynamics simulation model of the transmission dynamics of drug-sensitive tuberculosis (DSTB), multidrug-resistant tuberculosis (MDRTB) and HIV to estimate the impact of coverage with highly active antiretroviral therapy (HAART) and different cure rates for MDRTB in settings of explosive HIV epidemics and high MDRTB levels. Population coverage levels at 0%, 25%, 50%, 75% and 100% for HAART, and 5% and 80% of MDRTB treatment cure rates were simulated over a 10-year period and cumulative deaths from tuberculosis and HIV-associated tuberculosis were estimated for populations with latent tuberculosis, DSTB, MDRTB, HIV and HIV-associated tuberculosis. Depending on levels of HAART population coverage, increasing MDRTB cure rates from 5% to 80% reduces cumulative tuberculosis deaths by 1% and 13%. High population coverage with HAART (75% or higher), allied with high MDRTB cure rates, reduces cumulative deaths by 60%, with limited impact below this level. High coverage with HAART is required to substantially reduce the number of deaths from tuberculosis.

System dynamic simulation of treatment policies to address colliding epidemics of tuberculosis drug resistant tuberculosis and injecting drug users driven HIV in Russia.

AbstractThe explosive increase in the number of people infected with tuberculosis (TB), multi drug resistant tuberculosis (MDRTB), and injecting drug users (IDU) HIV/AIDS has become a serious public health challenge in Russia. The World Health Organization is recommending policies including simultaneous use of highly active antiretroviral therapy (HAART) to treat HIV/AIDS and second line drugs to treat MDRTB. We developed a System Dynamics simulation model to represent the dynamic transmission of TB, MDRTB and human immunodeficiency virus (HIV). The model simulated scenarios regarding MDRTB cure rate and HAART coverage, that is the HIV/AIDS population covered by HAART. The results over a 20-year period indicate that reduction in TB and HIV-associated TB deaths would be negligible for HAART coverage up to 50%. The reduction is only significant for HAART coverage of 70% and above. Similarly, high MDRTB cure rate reduces significantly deaths from TB and MDRTB and this reduction is more important as the HAART coverage is increased.

A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson’s disease in the United Kingdom

BackgroundThe number of people affected by Parkinson’s disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality.MethodsA Discrete Event Simulation model was developed to represent the PD care structure including patients’ pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model.ResultsShifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients.ConclusionsThe simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients and carers to help inform management choices and care plans.

A simulation-based decision support tool for informing the management of patients with Parkinson’s disease

We describe a decision support toolkit that was developed with the aim of assisting those responsible with the management and treatment of Parkinson’s disease (PD) in the UK. Having created a baseline model and established its face validity, the toolkit captures the complexity of PD services at a sufficient level and operates within a user-friendly environment; that is, an interface was built to allow users to specify their own local PD service and input their own estimates or data of service demands and capacities. The main strength of this decision support tool is the adoption of a team approach to studying the system, involving six PD specialist nurses across the country, ensuring that variety of views and suggestions are taken as well as systems modelling and simulations. The tool enables key decision-makers to estimate the likely impact of changes, such as increased use of community services on activity, cost, staffing levels, skill-mix and utilisation of resources. Such previously unobtainable quantitative information can be used to support business cases for changes in the increased use of community services and its impact on clinical outcomes (disease progression), nurse visits and costing.

Modelling length of stay and patient flows : Methodological case studies from the UK neonatal care services

The number of babies needing neonatal care is increasing mainly because of technological and therapeutic advances. These advances have implied a decreasing neonatal mortality rate for low birth weight infants and also a falling incidence of preterm stillbirth. Given the structural changes in the National Health Service in England, coupled with recession and capacity constraints, the neonatal system is facing some serious challenges, such as nurse shortages and the lack of cots, which could inevitably impact neonates’ length of stay, and the performance of the system as a whole. These constraints have forced neonatal managers to better understand their organisation and operations in order to optimise their systems. As a result, we have developed three unique methodologies based on length of stay modelling, physical patient pathways, and system dynamics modelling. This paper evaluates these techniques applied to neonatal services in London and showcases their usefulness and implications in practice, particularly focusing on patient flow to determine major drivers of the system, which could reduce inefficiencies, improve patient experience, and reduce cost.

Integrative mechanisms in new product development projects effect of project complexity on project performance

This paper investigates the effect of integration in new product development projects for projects with different levels of project complexity. The System Dynamics model results show that project complexity has negative effects on cycle time. Integration improves time performance although it cannot offset completely the negative effects in situations of high project complexity.

Using a decision support systems computer simulation model to examine HIV and tuberculosis: the Russian Federation.

The aim of this paper is to describe the development and use of a computer simulation model that can be used as a Decision Support System (DSS) to tackle the critical public health issues of HIV and HIV-related tuberculosis in the Russian Federation. This country has recently witnessed an explosion of HIV infections and a worrying spread of the Multi-Drug Resistant form of Tuberculosis (MDRTB). The conclusions drawn are that a high population coverage with Highly Active Anti-Retroviral Treatment (HAART) (75% or higher), allied with high MDRTB cure rates, reduces cumulative deaths by 60%, with limited impact below this level. This research offers a simulation model that can be applied as a DSS by public health officials to inform policy making. By doing so, ways of controlling the spread of HIV and MDRTB and reduce mortality from these serious public health threats is provided.

A model to determine effective HIV/AIDS and Multi-Drug Tuberculosis (MDRTB) treatment policies: a case study from the Russian Federation

Background The explosive increase in the number of people infected with tuberculosis, multi drug resistant tuberculosis (MDRTB), and injecting drug users (IDU) HIV/AIDS has become a serious public health challenge in Russia. The World Health Organization (WHO) is recommending policies including simultaneous use of highly active antiretroviral therapy (HAART) to treat HIV/AIDS and second line drugs to treat MDRTB. However, it is not clear what would be the impact of implementing these recommendations on tuberculosis and HIV/AIDS mortality. In this context, the aim of this research is to quantify the consequences of adopting these policies in terms of deaths reduction.