Optimal Vascular Access Choice for Patients on Hemodialysis

M. Reza Skandari (), Steven M. Shechter () and Nadia Zalunardo ()
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M. Reza Skandari: Operations and Logistics Division, Sauder School of Business, University of British Columbia, Vancouver, British Columbia V6T 1Z2, Canada
Steven M. Shechter: Operations and Logistics Division, Sauder School of Business, University of British Columbia, Vancouver, British Columbia V6T 1Z2, Canada
Nadia Zalunardo: Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada

Manufacturing & Service Operations Management, 2015, vol. 17, issue 4, 608-619

Abstract: Which vascular access to use is considered one of the most important questions in the care of patients on hemodialysis (HD). An arteriovenous fistula (AVF) is often considered the gold standard for delivering HD due to better patient survival, higher quality of life, and fewer complications. However, AVFs have some limitations: they require surgery, it takes approximately three months to know whether the surgery was successful, and a majority of these surgeries end in failure. Conversely, another common vascular access, the central venous catheter, can be inserted via a simple procedure and used immediately after placement. In this research, we address the question of whether and when to perform AVF surgery on incident and established HD patients, with the aim of finding individualized policies that maximize a patient’s probability of survival and remaining quality-adjusted life expectancy. Using a continuous-time dynamic programming model and under certain data-driven assumptions, we establish structural properties of the optimal policy for each objective. We provide further insights for policy makers through our numerical experiments.

Keywords: dynamic programming; medical decision making; optimal treatment policies; hemodialysis; vascular access (search for similar items in EconPapers)
Date: 2015
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Citations: View citations in EconPapers (6)

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