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Three essays on decision making in health care operations

  • In this thesis, we(1) use operations research methods to provide insights into three areas associated with health care operations management. In Chapter 2, we use a discreteevent supply chain simulation to asses if coordination among partners is beneficial in a supply chain with the characteristics of the German pharmaceutical market. We find that the greatest cost savings and service levels could be achieved through a highly integrated collaboration although most of its impact could already be achieved through sharing point-of-sales demand information. Results suggest that coordination is most beneficial in situations where product shelf life is short and demand variation is high. In Chapter 3 we consider quality-of-life maximizing sequences of prophylactic surgeries for female carriers of a BRCA1/2 genetic mutation, who face a significantly elevated breast and ovarian cancer risk. Using a Markov Decision Process model, we determine the optimal surgery sequence that maximizes the carrier’s expected lifetime qualityadjusted life years (QALYs). Baseline results demonstrate that a QALY-maximizing sequence recommends a bilateral mastectomy between ages 30 and 60 and bilateral salpingo-oophorectomy after age 40 for BRCA1 carriers. Surgeries are recommended later for BRCA2 carriers, as their cancer risk is lower. The model’s structural properties show that when one surgery has already been completed, there exists an optimal control limit after which performing the other surgery is always QALY-maximizing. In Chapter 4, we develop a two-stage model for optimizing when and where to assign Ebola treatment unit (ETU) beds—across geographic regions—during an infectious disease outbreak’s early phase. The first stage includes a dynamic transmission model that forecasts occurrence of new cases at the regional level, thus capturing connectivity among regions; in this stage we introduce a coefficient for behavioral adaptation to changing epidemic conditions. The second stage includes two approaches to efficiently allocate intervention resources across affected regions. Such an allocation could have prevented up to 3,434 infections over an 18-week period during the 2014 Ebola outbreak in West Africa, a 58% improvement compared with the actual allocation. (1) In Chapter 2, 3, and 4, the term ’we’ refers to the authors of Nohdurft & Spinler (2016), Nohdurft et al. (2016a), and Nohdurft et al. (2016b), respectively.

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Metadaten
Author:Eike Nohdurft
URN:urn:nbn:de:hbz:992-opus4-7300
Publisher:WHU - Otto Beisheim School of Management
Place of publication:Vallendar
Referee:Stefan Spinler, Arnd HuchzermeierORCiD
Document Type:Doctoral Thesis
Language:English
Date of Publication (online):2019/02/22
Publishing Institution:WHU - Otto Beisheim School of Management
Granting Institution:WHU - Otto Beisheim School of Management
Date of final exam:2017/01/27
Release Date:2019/02/22
Tag:Aufsatzsammlung; Betrieb; Entscheidungsfindung; Gesundheitswesen
Decision making; Essay collection; Healthcare sector; Operations
Page Number:176
Institutes:WHU Supply Chain Management Group / Kühne Institute of Logistics Management / Kühne Foundation Endowed Chair of Logistics Management
Licence (German):Copyright this PhD thesis