Collaborative Decision Model for Allocating Intensive Care Units Beds with Scarce Resources in Health Systems: A Portfolio Based Approach under Expected Utility Theory and Bayesian Decision Analysis

Abstract

The COVID-19 pandemic has brought health systems to the brink of collapse in several regions around the world, as the demand for health care has outstripped the capacity of their services, especially regarding intensive care. In this context, health system managers have faced a difficult question: who should be admitted to an intensive care unit (ICU), and who should not? This paper addresses this decision problem using Expected Utility Theory and Bayesian decision analysis. In order to estimate the chances of survival for patients, a structured protocol has been proposed conjointly with physicians, based on the Sequential Organ Failure Assessment (SOFA) score. A portfolio selection approach is proposed to support tackling the ICU allocation problem. A simulation study shows that the proposed approach is more advantageous than other approaches already presented in the literature, with respect to the number of lives saved. The patients’ probabilities of survival inside and outside the ICU are important parameters of the model. However, assessing such probabilities can be a difficult task for health professionals. In order to give due treatment to the imprecise information regarding these probabilities, a Monte Carlo simulation is used to estimate the probabilities of recommending a patient be admitted to the ICU is the most appropriate decision, given the conditions presented. The methodology was implemented in an Information and Decision System called SIDTriagem, which is available online for free. With regards to managerial implications, SIDTriagem has a great potential to help in the response to public health emergencies systems as it facilitates rational decision-making regarding allocating ICU beds when resources are scarce.