Browsing by Author "Sereo, Tumelo Donald"
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- ItemPopulation-level considerations for the treatment of lethal diseases in resource-limited settings(Stellenbosch : Stellenbosch University, 2023-03) Sereo, Tumelo Donald; Pulliam, Juliet RC; Stellenbosch University. Faculty of Science. Dept. of Mathematical Sciences.ENGLISH ABSTRACT: Diseases such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Ebola Virus disease (EVD), continue to challenge health systems worldwide. At the onset of outbreaks of unknown pathogens, there is often no cure, treatment or vaccine available to limit their impact. As the outbreak unfolds, randomised controlled trials are conducted, usually in patients with severe disease, to investigate candidate treatments. Often, several treatments end up being effective, raising the question of which one is most optimal to deploy. While clinical trials focus on individual-level outcomes, population-level outcomes are often more important for public health decision-making. This study answers two questions: First, when can a hypothetical treatment that increases hospital stay duration and probability of survival be used to improve the population-level mortality outcomes under constrained hospital capacity? Second, when is it preferable to invest in treatments versus beds, in a limited resource setting? We developed a transmission dynamic model, parameterised separately for SARS-CoV2 and Ebola, to address the questions posed. For the first question, we ran the model for baseline (no treatment) and treatment scenarios defined by the probability of surviving and duration of hospital stay. We used cumulative mortality as the metric to compare the population-level outcomes. The model shows that there is a substantial region of parameter space in which it is beneficial to use hypothetical treatments that increase probability of surviving and hospital stay duration. For the second question, we performed a cost-minimization analysis to examine when it is preferable to invest in treatments versus beds, in a limited resource setting. The model identified the number of additional beds that would be needed to obtain approximately the same outcomes compared to what is expected with existing treatments. We found that is it preferable to invest in additional beds rather than the existing treatments when the cost per course of treatment is greater than a threshold that depends on the drug under consideration. We estimated that this threshold is around R5 000 for existing SARS-CoV-2 drugs but higher for available Ebola therapies.