Thesis

Improving diabetes treatment in Ghana: modelling the health and economic benefits of public health interventions

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Awarding institution
  • University of Strathclyde
Date of award
  • 2025
Thesis identifier
  • T17298
Person Identifier (Local)
  • 201976679
Qualification Level
Qualification Name
Department, School or Faculty
Abstract
  • Although the burden of Diabetes Mellitus (DM) in Ghana is escalating, evidence to support decisionmaking on cost-effective interventions is extremely limited in this setting. While there is ample evidence on the impact of clinical and pharmacological interventions for blood glucose control (BGC), less is known about public health (PH) interventions. The health and economic benefits of PH interventions for BGC are particularly unclear. This is significant because BGC influences the progression of DM-related complications, which are associated with hospital admissions, high treatment costs, and reduced quality of life. The WHO has recommended sugar-sweetened beverage (SSB) taxes, expanding medicine access and Universal Health Coverage for controlling DM and other NCDs, and there is evidence of their effectiveness in many countries. However, evidence of the policies' cost-effectiveness in Ghana is limited. The understanding of how patient behaviour interacts with clinical services and PH policies within Ghana's socioeconomic environment is also limited. As a first step, this research seeks to improve understanding of the dynamic patients' SMB and how it influences BGC, medicine adherence and clinical outcomes using agent-based modelling (ABM). The research then combines ABM with cost-effectiveness analysis (CEA) to examine the health and economic benefits of selected PH interventions: a 20% SSB tax, expanding medicine availability and insurance coverage. ABM captures the complexity and heterogeneity of patients' SMB. Manual code verification, Whitebox testing, face validation, and scenario and probabilistic sensitivity analysis are used to build confidence in the ABM model. CEA compares the health outcomes and economic efficiency of the selected PH interventions, generating evidence to support policy decision-making. This research makes various theoretical, methodological, empirical, and practical contributions. From a theoretical perspective, the research provides a conceptual model of the socioeconomic environment and clinical service delivery system, which is crucial for improving understanding of DM patients' SMB and BGC outcomes and designing interventions. The second theoretical contribution is the development of an agent-based conceptual model for simulating individual patients' SMB and how such behaviours and interactions contribute to cohort-level BGC outcomes. From a methodological perspective, this research contributes to the decision analytical modelling and health technology assessment field by applying ABM and CEA to study patients' treatment behaviour and examine the health and economic impact of selected PH interventions on patients and the government. It also applied the health belief model and the theory of planned behaviour to conceptualise SMB. Lastly, the research makes two empirical contributions. It helps improve understanding of how the patients' SMB, clinical services, and PH policies influence BGC at a cohort level. It provides insights on the cost-effectiveness of SSB tax, expanding insurance coverage and increasing medicine availability from a government and patient perspective to support policy decision-making. Opportunities for future research and data surveillance are proposed.
Advisor / supervisor
  • Meer, R. van der (Robert)
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DOI

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