University of Stellenbosch Business School (USB)

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Browsing University of Stellenbosch Business School (USB) by browse.metadata.advisor "Burger, Ronelle"

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    Cost-effectiveness analysis of radiofrequency ablation versus drugs for the treatment of a trial fibrillation in the South African population
    (Stellenbosch : Stellenbosch University, 2021-03) Henry-Lines, Heather; Burger, Ronelle; Young, Taryn; De Klerk, Mias; Stellenbosch University. Faculty of Economic and Management Sciences. University of Stellenbosch Business School.
    ENGLISH SUMMARY : Atrial fibrillation is the most commonly found and sustained arrhythmia. It affects about 1% of the total population and is found in more than one in ten in the elderly. The prevalence is increasing with the aging population. Patients with atrial fibrillation are at an increased risk of heart failure and all-cause mortality, and have a fivefold increased risk of stroke. Atrial fibrillation is associated with debilitating symptoms and an impaired quality of life. The restoration and maintenance of sinus rhythm is favourable and the current guidelines recommend the use of both rate and rhythm control strategies, which involve the prescription of anti-arrhythmic drug therapy. These anti-arrhythmic drugs are frequently ineffective, with large studies showing that atrial fibrillation returns in as many as 85% of patients within one year. These drugs are also associated with adverse events, occasionally serious, which may lead to hospitalisation. Catheter ablation (a minimally invasive procedure), has over the past decade revolutionised the treatment of atrial fibrillation. The 2010 European Society of Cardiology guidelines recommend catheter ablation for paroxysmal atrial fibrillation as a class IIa recommendation with level of evidence “A”. Current literature indicates that patients with atrial fibrillation who undergo pulmonary vein ablation have a significantly lower risk of death, stroke and dementia compared to patients with atrial fibrillation who are not treated with ablation, while stroke and dementia is similar to that of the general population. This study used a decision tree analysis, a Markov model and Monte Carlo simulation to calculate the cost-effectiveness of catheter ablation versus commonly used anti-arrhythmic drugs for the treatment of paroxysmal atrial fibrillation. Input into the model was founded on an extensive literature review, interviews with local electrophysiologists and a sample of real patient data, which examined the costs associated with among others, the length of hospital stay and the cost of the procedure. The model simulated 1 000 patients receiving either pulmonary vein isolation through radiofrequency ablation or anti-arrhythmic drugs and the following variables were measured, QALYs, average cost, incremental costs, average effectiveness, incremental effectiveness, average length of stay in hospital for complications, relative risk of death for radiofrequency catheter ablation versus anti-arrhythmic drugs and also the net monetary benefits. A total of fourteen variables were tested and sensitivity analyses were performed on each. It was found that in all but two cases, pulmonary vein isolation with radiofrequency catheter ablation dominated over anti-arrhythmic drug therapy as being more cost-effective for the management of paroxysmal atrial fibrillation. Finally, it was determined that pulmonary vein isolation with radiofrequency catheter ablation should be considered as a first line therapy for patients with paroxysmal atrial fibrillation in South Africa.
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    Understanding the financial vulnerability and the financial decisions of non-governmental organisations: an empirical study of Ugandan NGOs
    (Stellenbosch : Stellenbosch University, 2018-03) Arsenio da Silva, Berta; Burger, Ronelle; Morrison, John Myburgh; Stellenbosch University. Faculty of Economic and Management Sciences. University of Stellenbosch Business School.
    ENGLISH SUMMARY: Non-governmental organisations (NGOs) are key providers of essential services in developing countries, where government capacity is often limited. Despite their important role in socio-economic development and poverty reduction, NGOs in developing countries tend to be reliant on either a few foreign donors or on local communities’ contributions. In addition to the short contract periods and associated project risks, foreign funding is challenging and onerous as a result of information asymmetries and lack of transparency. Only a minority of larger and well-established NGOs can access reliable funding from international donors, whilst the remaining NGOs are financially vulnerable and struggle to survive. This is of grave concern to the societies within which these organisations operate as it can lead to the interruption of the delivery of critical services to beneficiaries. There are a number of studies on the financial vulnerability and associated coping strategies of NGOs in developed countries, but not in developing countries. This research aims to address this gap in the literature by investigating the nature of financial vulnerability and exploring the effective coping mechanisms implemented by NGOs in such contexts to deal with financial challenges and to ensure sustainability of the organisation and its programmes. To achieve the stated objective, the research investigates the financial vulnerability and stability of NGOs, focusing on the country case study of Uganda. The research adopts an empirical approach, using methodologies that have previously been used for developed countries to investigate the possible relationship between an organisation’s characteristics and its financial vulnerability. It subsequently focuses more narrowly but also more in depth on the subsample of NGOs in Uganda that have experienced a large decrease in revenue, applying a comparative technique that respects the organisations’ heterogeneity and allows testing for conditional relationships between different organisational factors (i.e. conditions that can mitigate the impact of financial vulnerability on programme expenditures). Finally, the research applies a qualitative, interpretive approach in order to gain a better understanding of the preliminary findings and the funding environment of Ugandan NGOs. It draws from 35 in-depth interviews with Ugandan NGO managers conducted during 2016. The respondents provide valuable insights that help to explain financial decisions and outline the coping strategies of NGOs to ensure financial survival and safeguard their commitment to their mission and to service delivery. Findings from the research indicate that financial vulnerability is a persistent and prevalent problem that affects the majority of local NGOs in Uganda as a consequence of uncertainty of funding flows. However, the way an organisation is affected depends on its expenditure and financial structure. A large variety of proposed coping strategies amongst organisations were identified. NGOs in Uganda have been proactive and innovative in exploring alternative funding sources to protect themselves against financial risks, especially those related to dependence on foreign funding. The lessons learnt from this research are useful both for NGO managers who are concerned about financial risk and vulnerability, but also more broadly for the community of development practitioners. The recommendations can assist NGOs to sustain their programmes on the ground and improve the financial stability of the NGO sector. This research contributes to the academic dialogue on financial vulnerability by providing a credible voice to NGOs, explaining their fears and their challenges. Further research is recommended to investigate the financial vulnerability of NGOs in other country contexts.