Abstract
Title: Pediatric Burkitt’s Lymphoma in Ghana: A Decision-Analytic Model and Preliminary Cost-Effectiveness Analysis Methods: In the study performed in this thesis, academic literature for the clinical progression of pediatric Burkitt's Lymphoma was used to pilot a novel decision tree model to simulate the clinical progression and outcomes of the disease. A preliminary cost-effectiveness analysis was performed using this decision-analytic model. The parameters for the preliminary analysis were populated using data from Ghanaian sources when applicable, and sources from similar settings when necessary. Deterministic and probabilistic sensitivity analyses were performed in order to account for structural and parameter uncertainty, and to identify the parameters with the largest impact on the cost-effectiveness of pediatric Burkitt's Lymphoma treatment in Ghana. Results: The decision-analytic model was able to produce outcomes similar to observed pediatric Burkitt's Lymphoma outcomes in Ghana. Deterministic sensitivity analysis indicated annual fixed costs, treatment abandonment and advanced-stage treatment efficacy to be among the most influential parameters. The preliminary cost-effective analysis produced an Incremental Cost-Effectiveness Ratio of $301 per DALY averted. In the probabilistic sensitivity analysis, 99.85% of iterations were under the threshold for being considered very cost effective, with the cost per DALY averted being less the $2202 GDP per capita of Ghana. Fixed costs of treatment and treatment abandonment were among the parameters with the highest impact on the cost-effectiveness of pediatric Burkitt's Lymphoma treatment in Ghana Conclusion: Through this study, a novel decision tree model for the simulation of pediatric Burkitt's Lymphoma outcomes in Ghana was created. Through sensitivity analysis, this model was able to identify the parameters that had the largest impact on the cost-effectiveness of pediatric Burkitt's Lymphoma treatment in Ghana. The preliminary cost-effectiveness analysis based on this model indicated NHIS-funded treatment to be likely to be very cost effective compared to the current practice in Ghana.