The unifying theme of this dissertation is the application of decision analytic methods to diverse public health problems in underserved populations.
Chapter I presents our cost-effectiveness analysis of rapid point-of-care prenatal syphilis screening in sub-Saharan Africa. Syphilis infection in pregnancy poses deleterious consequences to maternal and infant health. While treatment with penicillin is highly effective and inexpensive, identification and timely treatment of infected women often falls short due to logistical and technical obstacles. New rapid testing technologies are available with the potential to improve diagnosis and treatment of infection during pregnancy. We developed a Markov model of the natural history of syphilis in pregnancy in the sub-Saharan Africa setting to assess the benefits, cost-effectiveness and policy implications of universal on-site prenatal syphilis screening and treatment using rapid diagnostic tests versus standard testing methods. We found that syphilis screening with new rapid tests that allow for same day testing and treatment was cost-effective and had the potential to provide substantial benefits by preventing adverse outcomes.
In Chapter II we describe a series of exercises conducted as we re-parameterized a widely-cited state transition model of HIV disease to address clinical and policy questions relevant to HIV-infected women in the United States. Data were extracted from the Women's Interagency HIV Study (WIHS). We leveraged this effort to: (1) assess internal consistency of the model, (2) identify influential assumptions on model outcomes, and (3) assess external validity of the model. We found that the calibrated model demonstrated good internal consistency and external validity with empiric data.
Chapter III examines the cost-effectiveness of different treatment options for panic disorder. Panic disorder is often debilitating, resulting in decreased quality of life and reduced productivity. We developed a 1st order Monte Carlo simulation model of the natural history of panic disorder and treatment to assess the cost effectiveness and impact of different treatment strategies on burden of disease. Our analysis supports conclusions that treatment of panic disorder is cost-effective even at low cost-effectiveness thresholds and can substantially reduce time spent with disease. However, intervention characteristics, patient heterogeneities and disease course have important implications on treatment choice.
|Advisor:||Goldie, Sue J.|
|School Location:||United States -- Massachusetts|
|Source:||DAI-B 71/07, Dissertation Abstracts International|
|Subjects:||Public health, Health care management|
|Keywords:||Decision analysis, HIV, Markov model, Monte Carlo model, Panic disorder, Syphilis screening, Underserved|
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