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Existing strategies for determining the optimal treatment or monitoringstrategy typically assume unlimited access to resources. However, when a healthsystem has resource constraints, such as limited funds, access to medication,or monitoring capabilities, medical decisions must balance impacts on bothindividual and population health outcomes. That is, decisions should accountfor competition between individuals in resource usage. One simple solution isto estimate the (counterfactual) resource usage under the possibleinterventions and choose the optimal strategy for which resource usage iswithin acceptable limits. We propose a method to identify the optimal dynamicintervention strategy that leads to the best expected health outcome accountingfor a health system's resource constraints. We then apply this method todetermine the optimal dynamic monitoring strategy for people living with HIVwhen resource limits on monitoring exist using observational data from theHIV-CAUSAL Collaboration.

A Note on Estimating Optimal Dynamic Treatment Strategies Under Resource Constraints Using Dynamic Marginal Structural Models