Title:
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The synergy between system dynamics and the Coxian phase-type distribution : an application in healthcare modelling
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Health systems of developed countries around the world are facing immense pressure. This is due to an
ageing population and an increase in the prevalence of chronic disease. The purpose of this research is to
develop the system dynamics Coxian phase-type (SDC-Ph) model which consists of inter-related components
each one being a system dynamics model. This will serve as a framework for investigating the change in
prevalence of coronary heart disease in Northern Ireland between 2007 and 2027 and the implications this
will have on coronary heart disease (CHD) related inpatient admissions. The first component of the
framework is the coronary heart disease prevalence model. It incorporates the changes anticipated in
population size and age structure, risk factor prevalence, and primary and secondary interventions and the
impact this will have on prevalence over the twenty year time period. The second component of the
framework is the coronary heart disease hospital admissions model. It is a composite model which combines
the system dynamics methodology with the Coxian phase-type distribution to represent the flow of patients
with coronary heart disease through hospital and is used to determine the impact of the changing prevalence
on the demand for acute care beds. The final component of the framework is the coronary heart disease cost
model. It uses the results obtained from the fit of the Coxian phase-type distribution to group patients
together according to their likely time of discharge from hospital thus allowing inferences to be made
regarding the costs associated with the individual's phase of care. The SDC-Ph model allows testing of
different healthcare interventions taking aspects of population dynamics such as the ageing population into
account and forecasts future population incidents and associated costs. It allows healthcare providers to
model the impact of interventions and thus assist in the decision making process.
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