Optimal Implantable Cardioverter Defibrillator (ICD) Generator Replacement
Associate Professor Oleg Prokopyev, University of Pittsburgh
24th May 2013 11:00 am - Room 498 Merewether Building H04
Implantable Cardioverter Defibrillators (ICDs) include small, battery powered generators, the longevity of which depends on a patient's rate of consumption. Generator replacement, however, involves risks. Hence, a trade-off exists between prematurely exposing the patient to these risks and allowing for the possibility that the device is unable to deliver therapy when needed. Currently, replacements are performed using a one-size-fits-all approach. Here, we develop a Markov decision process model to determine patient-specific optimal replacement policies as a function of patient age and the remaining battery capacity. We analytically establish that the optimal policy is of threshold-type in the remaining capacity, but not necessarily in patient age. We conduct a large computational study that suggests that under the optimal policy, patients see a considerable decrease in the total expected number of replacements, while achieving the same or greater expected lifetime.