The University of Pretoria paves the way for international career opportunities

Dr Carina Behr, a UP graduate in industrial engineering, is making a name for herself in the field of health economic modelling in The Netherlands. After graduating from the University of Pretoria (UP) in 2017, she embarked on postgraduate studies at the University of Twente. After obtaining a master’s degree in industrial engineering and management, she completed her PhD with a dissertation titled: “Extending lung cancer screening: three diseases, one scan”.

Her interest in the application of industrial engineering principles in the biomedical field was sparked by her lecturer at UP, Roland Röhrs, who introduced her to the interesting research that the University of Twente’s Industrial Engineering Department was doing in hospitals in The Netherlands. This prompted her to pursue her postgraduate studies there.

Her doctoral research was funded by ZonMw, an agency of the government of The Netherlands that funds research and innovation in health, healthcare and wellbeing, who identified her as a suitable candidate. Her research formed part of a larger study, which included five individual doctoral research projects in different fields, including computer science and biomedical engineering. The overall focus of these projects was on multi-disease screening.

Her research was of particular interest to Dutch public health authorities, and finds application in other countries across the world. It sought to explore the cost-effectiveness of including screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease in a screening programme for lung cancer, which is a highly prevalent disease globally with a high mortality rate. This is known as Big-3 screening. It is considered since individuals who are invited for lung cancer screening are often at risk for other diseases as well, since they have overlapping risk factors (smoking and ageing). Simultaneously screening for multiple diseases could therefore have added health benefits at marginal additional costs. The significance of her research from a public health perspective lies in the fact that it is beneficial to identify the most cost-effective screening programme to ensure that the most health benefits are achieved for the money invested.

Her study included a simulation model to evaluate the maximum acceptable cost of Big-3 screening to estimate whether it has health economic potential. The results of her research suggested that the costs associated with including cardiovascular disease in lung cancer screening could be considered acceptable. She also found that the costs of including COPD screening as well, although higher, were also still acceptable given the added health benefits that would contribute to the sustainability of the healthcare system.

Dr Behr believes that the degree in Industrial Engineering that she obtained from the University of Pretoria put her in good stead to study and work overseas. In particular, the fact that she had learnt to work with people from diverse backgrounds gave her an added advantage when it came to working with people from different countries at the University of Twente, which attracts students from across the world. She admits that, although she had to learn how the biomedical industry works to make a contribution in this discipline, it was a field that interested her. Her background in industrial engineering enabled her to provide a unique perspective by designing simulation models to determine the cost-effectiveness of the health screens that she was studying.

After completing her PhD research, Dr Behr started working as a health economist at the market research and analytics company Lumanity in Utrecht, The Netherlands. Her work is related to the topic of her research, as it entails doing cost-effectiveness analyses of new pharmaceuticals that are developed. These studies are performed on behalf of pharmaceutical companies for health technology assessment agencies, and form part of the applications for the approval of these pharmaceuticals in different countries.

Although much of the work she is engaged in has a northern-hemisphere application, she explains that South Africa will always hold a special place in her heart, and she always makes an effort to involve herself in projects that promote Africa and African health problems.

She is a founding member of the R for Health Technology Assessment in low- and middle-income countries (R-HTA LMIC) consortium, which includes health economists from South Africa and Argentina. This is an academic consortium with the main objective of exploring the use of the programming language, R, for cost-effectiveness analysis as an alternative to less efficient, generalisable and powerful software, such as spreadsheets. The consortium provides online workshops that enable researchers and industry specialists from low- and middle-income countries to build complex models in a free programming environment.