  Existing strategies for determining the optimal treatment or monitoring
strategy typically assume unlimited access to resources. However, when a health
system has resource constraints, such as limited funds, access to medication,
or monitoring capabilities, medical decisions must balance impacts on both
individual and population health outcomes. That is, decisions should account
for competition between individuals in resource usage. One simple solution is
to estimate the (counterfactual) resource usage under the possible
interventions and choose the optimal strategy for which resource usage is
within acceptable limits. We propose a method to identify the optimal dynamic
intervention strategy that leads to the best expected health outcome accounting
for a health system's resource constraints. We then apply this method to
determine the optimal dynamic monitoring strategy for people living with HIV
when resource limits on monitoring exist using observational data from the
HIV-CAUSAL Collaboration.
