Thesis Title: Essays on Healthcare Economics and Outcomes Research

Advisor:

Dr. Turgay Ayer, School of Industrial and Systems Engineering, Georgia Institute of Technology

Thesis Committee:

Dr. Jagpreet Chhatwal, Institute for Technology Assessment, Massachusetts General Hospital

Dr. Pinar Keskinocak, School of Industrial and Systems Engineering, Georgia Institute of Technology

Dr. David Goldsman, School of Industrial and Systems Engineering, Georgia Institute of Technology

Dr. Lauren Steimle, School of Industrial and Systems Engineering, Georgia Institute of Technology

Date and Time: Tuesday, July 11th, 2023, 9:00 am EDT

Meeting Link: https://gatech.zoom.us/j/98434125496

Abstract: 

Simulation modeling is a mainstay in the toolbox of systems management. They explicitly model the inner workings of a system and can be used to predict the outcome of changes to system parameters. This is especially useful when the system is very complex or when experimentation is impractical or unethical. Rapid advancements in computational power are increasing the scale of simulations that can be built, making them ever more popular. Due to their high degree of interpretability, simulation has long been used in medical and public health decision making. In this thesis, we continue its history of use by presenting applications to three current and important epidemics.

In Part I, we present the COVID-19 Policy Simulator, an online tool for simulating the trajectory of the COVID-19 pandemic under different non-pharmaceutical interventions. Chapter 1 serves as its official documentation, describing its purpose, evolution, contributions, and societal impact. Chapter 2 extends the model in Chapter 1 in an analysis of periodic revaccination strategies for COVID-19 post-pandemic management. We show that fast, aggressive revaccination can have an unintended downstream effect of inducing large recurrent epidemics, while a slower pace of revaccination can reduce system volatility and “flatten the curve.”

In Part II, we focus on nonalcoholic fatty liver disease (NAFLD). Chapter 3 is a cost-effectiveness analysis of the American Gastroenterological Association’s recently published Clinical Care Pathway for the management of NAFLD in patients with type 2 diabetes mellitus. Chapter 4 is motivated by the increasing body of evidence suggesting heritability of NAFLD, in particular, NAFLD-related liver fibrosis. We propose a method for generating first-degree relative networks with familial aggregation of NAFLD that can be used to evaluate cost-effectiveness of familial screening policies.

In Part III, we develop a microsimulation model of the opioid epidemic in four Kentucky counties that are part of the landmark HEALing Communities Study (HCS). We derive a counterfactual scenario in which HCS interventions did not take place during 2020 to 2021, and used the difference to quantify the effectiveness of interventions. Model outputs suggest that HCS interventions had a modest impact on the opioid epidemic. Additional resources are needed to scale up interventions.