ORIGINAL RESEARCH article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1550504
This article is part of the Research TopicSystem Dynamics Modeling in Public Health: Implementations and ImplicationsView all 7 articles
COMPARATIVE-EFFECTIVENESS OF POLICY INTERVENTIONS FOR SEVERE SYMPTOMATIC AORTIC STENOSIS MANAGEMENT IN SAUDI ARABIA: A SYSTEM DYNAMICS SIMULATION
Provisionally accepted
Hussain Al-Omar1*
Abdulaziz Alrabiah2Khalid Ibrahim Alabdulkarim3Adel Tash2
Adham Salem4
João Carapinha5,6René Carapinha7- 1King Saud University, Riyadh, Riyadh, Saudi Arabia
- 2Saudi Health Council, Riyadh, Saudi Arabia
- 3Ministry of Health (Saudi Arabia), Riyadh, Riyadh, Saudi Arabia
- 4Edwards Lifesciences, Dubai, United Arab Emirates
- 5Northeastern University, Boston, United States
- 6Syenza, Anaheim, United States
- 7Syenza, Boston, United States
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Severe symptomatic aortic stenosis (SAS) is undertreated in Saudi Arabia, leading to high morbidity and mortality. This study aims to identify effective policies to improve SAS management, aligning with Saudi Arabia's 2030 health goals.A System Dynamics model simulated SAS progression and care pathways for patients aged ≥65 in Saudi Arabia. The model considered rising prevalence, aging population, disease progression, and management delays. An aging-chain represented stages of SAS severity (noncritical, critical, very severe) and care pathways (detection, diagnosis, referral, treatment). Transition rates were based on patient health-seeking behavior and healthcare system efficacy, informed by empirical data, expert consultations, and literature reviews. The simulation, covering 2019-2044 with yearly time units, used deterministic and differential equations solved via Euler's method. Validation compared simulated data with historical and projected SAS prevalence and AVR treatments, using R² and MAD as goodness-of-fit statistics, and sensitivity analysis to ensure robustness and reliability.Results: SAS prevalence is projected to rise from 26,500 in 2024 to 37,800 by 2030, with 63% of patients remaining undetected and only 6% receiving AVR in 2024. Routine screening is estimated to reduce mortality by 16% and increase AVR treatment by 34%. Awareness campaigns targeting patient care-seeking behaviour reduce mortality by 14% and increase AVR by 30%. Combined primary healthcare interventions reduce mortality by 45% and double AVR uptake, demonstrating greater impact than interventions at secondary or tertiary care levels. One-way sensitivity analysis confirmed that model results are robust, supporting the finding that PHC interventions exert greater leverage on SAS outcomes.Primary healthcare interventions significantly reduce SAS mortality and increase AVR treatment rates in Saudi Arabia. Implementing these policies and allocating resources effectively can substantially improve SAS outcomes, despite limitations at secondary and tertiary levels.
Keywords: Aortic Valve Stenosis, Saudi Arabia, policy, Critical Pathways, Primary Health Care, Referral and Consultation, System Dynamics Simulation Pages:14
Received: 23 Dec 2024; Accepted: 29 Jul 2025.
Copyright: © 2025 Al-Omar, Alrabiah, Alabdulkarim, Tash, Salem, Carapinha and Carapinha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hussain Al-Omar, King Saud University, Riyadh, 11451, Riyadh, Saudi Arabia
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