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Estimating optimal dynamic treatment strategies under resource constraints using dynamic marginal structural models.

Ellen C Caniglia1, Eleanor J Murray2, Miguel A Hernán3,4

  • 1Department of Population Health, New York University School of Medicine, New York, USA.

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|June 29, 2021
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Summary

This study introduces a new method for optimizing treatment strategies under resource constraints, like limited monitoring for people living with HIV. It ensures effective care while managing healthcare system limitations.

Keywords:
HIVdynamic strategymarginal structural modelsmonitoringoptimal strategyresource constraints

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Area of Science:

  • Health economics
  • Biostatistics
  • Public health

Background:

  • Optimal treatment strategies often assume unlimited resources, which is unrealistic in healthcare.
  • Resource constraints necessitate considering competition for limited funds, medications, and monitoring.
  • Existing methods for resource-constrained treatment strategies are limited to single-time-point decisions.

Purpose of the Study:

  • To develop a method for determining optimal dynamic treatment strategies under resource constraints.
  • To address the challenge of generalizing resource-constrained optimal strategies to time-varying scenarios.
  • To apply the novel method to optimize monitoring for people with HIV under resource limitations.

Main Methods:

  • Employed dynamic marginal structural models to estimate counterfactual resource usage.
  • Targeted optimal strategies within a clinically defined subclass to simplify the problem.
  • Solved a constrained optimization problem to select strategies with acceptable expected resource usage.

Main Results:

  • Successfully adapted methods for optimal treatment strategies to resource-limited settings.
  • Developed a framework to evaluate dynamic treatment strategies considering resource competition.
  • Applied the method to identify optimal dynamic monitoring strategies for people living with HIV.

Conclusions:

  • The proposed method effectively integrates resource constraints into dynamic treatment strategy optimization.
  • This approach allows for the development of clinically relevant and resource-aware treatment plans.
  • The findings have implications for managing chronic diseases like HIV in resource-constrained health systems.