On the frontlines of healthcare assessment and improvement
- Feb 15, 2022
Applying her expertise in the mathematical modeling of infectious diseases, Ivey’s Lauren Cipriano is doing her best to support our community’s fight against COVID-19 and provincial efforts to reduce the impact of the global pandemic.
As a member of Ontario’s COVID Modelling Consensus Table (MCT), Cipriano and her colleagues use their expertise in data analytics and decision science to develop projections of the prevalence of the virus throughout the province.
The MCT meets at least once a week and seeks out input from a wide variety of experts in areas like biostatistics and epidemiology. The group looks to interpret local and international data informing their model inputs, targets, as well as judging the effectiveness of public health measures, vaccines, and available COVID treatments.
“Among those experts, the MCT has several groups of modelers who do projections for Ontario's COVID infections, hospitalizations, and ICU capacity,” said Cipriano. “The frequency of projections varies based on the situation. In the fall, we were doing updates every three weeks. Right now we are doing them constantly, incorporating updated model parameters and new sources of data.”
This vital information helps to inform policy makers about what to expect in the days and weeks to come. It allows policy makers and the public to understand the impact of their choices on the trajectory of the pandemic in our community. Understanding the intensity and duration of a wave of cases is especially important for hospitals to plan their staffing, allocate resources, and consider steps such as postponing elective surgeries.
“The Omicron variant changed the situation in Ontario dramatically. Vaccines and vaccine certificates gave us substantial protection against transmission in the fall, enabling near normal activity in many aspects of our lives,” said Cipriano. “Fortunately, vaccines still provide substantial protection against severe outcomes including hospitalization, but two doses of vaccine alone provides much less protection against infection with Omicron than it did against Delta. This reminded us of how fragile the balance is between protecting our hospitals and public health measures; and how tenuous any political commitments are to maintaining a specific level of public health restrictions in the face of emerging new variants.”
One of the current challenges facing modelers is the recent change in testing access. Throughout most of the pandemic, the eligibility for, and access to, testing has remained relatively consistent. With the Omicron wave, the demand for testing greatly exceeded testing capacity. As a result, the proportion of infections that have been diagnosed decreased rapidly. Increasing the challenge, the MCT is now relying on more heavily on lagging indicators, such as hospitalizations, routine testing in selected populations, and waste water signals.
While the limited access to testing has provided its challenges, Cipriano and her colleagues are confident their ability to adapt has provided sound analysis and guidance for decision makers.
“Models can help decision makers explore the relative impact of their choices on downstream consequences, such as hospital admissions and ICU utilization. Models also help understand which of many uncertainties are key to driving outcomes. In this past round of modelling, MCT analysis identified the key uncertainty influencing hospitalizations in February and March was the total number of infections that occurred over December and January, that regardless of this uncertainty, opening high-contact environments too quickly would lead to an increase in cases and hospitalizations, and that a key policy action able to reduce the risk of overwhelming hospitals is to increase the rate at which 3rd doses of vaccine are distributed across Ontario communities.”
Combating antimicrobial resistance
While her work on COVID modelling has taken centre stage of late, Cipriano has a number of other areas of ongoing critical research. One such area is addressing issues around antimicrobial resistance, which is considered a priority global threat according to the Centres for Disease Control and the World Health Organization.
Over the last 25 years, there has been very little research effort to development new antibiotics. As result there is increasing evidence of antimicrobial resistance, meaning infections that were once treatable are becoming either untreatable, or very expensive to treat.
In an effort to develop strategies to combat this major concern, Cipriano and colleagues from Laurier University and London Health Sciences Centre are working on a number of projects including evaluating physician compensation and pay-for-performance schemes aimed at reducing inappropriate antibiotic prescription.
“Antimicrobial resistance is an important threat to our way of life and to our economy. Without new antimicrobials, currently standard medical care and hospital procedures will no longer be possible,” said Cipriano. “Policies that incentivize innovation are in conflict with existing antimicrobial stewardship programs that extend the useful life of existing antimicrobials. Policy modelling can inform how best to manage the trade-offs between innovation and the sustainability of current technologies, evaluate the cost-effectiveness of various stewardship programs, and project the long-term impact of these efforts on the trajectory of antimicrobial resistance.”
Health technology adoption
Another pillar of Cipriano’s research work is looking at new methods for calculating the economic value of health care technologies. While budget constraints are not a new reality for Canada’s healthcare system, every decision to invest in a new, more expensive health technology diverts resources towards one group of patients and away from other groups of patients.
“Sustainability of the health care system requires systematic evaluation of these trade offs,” said Cipriano. “It is important to assess the equity implications of health policy decisions and evaluate the development of payment schemes so that the risk of expensive new technologies with limited evidence of efficacy is not borne solely by Canadian tax payers.”
Recent advances in biomedical science are leading to the tailoring of medical treatments to individual patients, creating new challenges in how treatment efficacy is demonstrated and how the health economic benefits of new technologies are being evaluated. With these advances and challenges in mind, Cipriano is leading several investigative projects:
- In conjunction with the Canadian Agency for Drugs and Technologies in Health (CADTH) Health Economics Advisory Council, developing guidelines for evaluating genetically-tailored cancer technologies
- With Ivey’s Greg Zaric and PhD student Hossein Reihani, establishing a framework to advise decision makers on when to invest in collecting additional information about a health care technology -- and whether to invest directly in research subsidies or indirectly by providing provisional access to the technology through the health care system
- With collaborators at Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Hospital, and the University Ottawa, developing a detailed microsimulation model of diabetes, cardiovascular, and cerebrovascular disease to evaluate novel therapies in diabetes affecting multiple disease pathways
- Along with collaborators at London InterCommunity Health Centre, performing a program evaluation of the Emergency Safer Supply prescription opioid program to understand the impacts beyond the health care system, including housing, social services, and criminal justice.
Last year, Cipriano was named a Canada Research Chair placing her among the top scholars and scientists in her field.