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Cost-effectiveness analysis protocol of the Smart Triage program: A point-of-care digital triage platform for
Edmond C K Li1, Sela Grays2, Abner Tagoola3
1School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
This study evaluates the cost-effectiveness of the Smart Triage program, an electronic system for expedited pediatric sepsis treatment in Uganda. The analysis aims to inform improvements and wider implementation of this digital health intervention in low-resource settings.
Area of Science:
- Health Economics
- Digital Health Interventions
- Pediatric Sepsis Management
Background:
- Sepsis poses a significant mortality risk, especially in low-middle income countries, with early diagnosis and treatment being crucial.
- The Smart Triage program utilizes a data-driven electronic system to expedite pediatric sepsis care at Jinja Regional Referral Hospital, Uganda.
- A concurrent cost-effectiveness analysis is proposed to complement the ongoing interventional trial.
Purpose of the Study:
- To evaluate the cost-effectiveness of the Smart Triage electronic patient triage system for pediatric sepsis in Uganda.
- To provide data for informing future modifications and motivating the scale-up of the Smart Triage platform.
Main Methods:
- A decision-analytic model from a societal perspective, incorporating government and out-of-pocket costs.
- Utilizing previously published secondary data to link healthcare utilization, costs, and mortality.
- Employing probabilistic sensitivity analysis and cost-effectiveness acceptability curves to model uncertainty.
Main Results:
- The analysis represents a novel approach to evaluating digital triage for pediatric sepsis in low-resource settings.
- It links secondary costing data, post-discharge utilization, and clinical endpoints within a decision-analytic framework.
- Findings will inform future platform modifications and motivate wider implementation.
Conclusions:
- The proposed cost-effectiveness analysis is a crucial first step in assessing the value of the Smart Triage platform.
- This innovative digital health approach has the potential to improve pediatric sepsis outcomes in resource-limited environments.
- Subsequent analyses on budget impact and scale-up will guide national-level adoption.
Background:
Sepsis is a clinical syndrome characterized by organ dysfunction due to presumed or proven infection. Severe cases can have case fatality ratio 25% or higher in low-middle income countries, but early diagnosis and timely treatment have a proven benefit. The Smart Triage program in Jinja Regional Referral Hospital in Uganda will provide expedited sepsis treatment in children through a data-driven electronic patient triage system. To complement the ongoing Smart Triage interventional trial, we propose methods for a concurrent cost-effectiveness analysis of the Smart Triage platform.
Methods:
We will use a decision-analytic model taking a societal perspective, combining government and out-of-pocket costs, as patients bear a sizeable portion of healthcare costs in Uganda due to the lack of universal health coverage. Previously published secondary data will be used to link healthcare utilization with costs and intermediate outcomes with mortality. We will model uncertainty via probabilistic sensitivity analysis and present findings at various willingness-to-pay thresholds using a cost-effectiveness acceptability curve.
Discussion:
Our proposed analysis represents a first step in evaluating the cost-effectiveness of an innovative digital triage platform designed to improve clinical outcomes in pediatric sepsis through expediting care in low-resource settings. Our use of a decision analytic model to link secondary costing data, incorporate post-discharge healthcare utilization, and model clinical endpoints is also novel in the pediatric sepsis triage literature for low-middle income countries. Our analysis, together with subsequent analyses modelling budget impact and scale up, will inform future modifications to the Smart Triage platform, as well as motivate scale-up to the district and national levels.
Trial Registration:
Trial registration of parent clinical trial: NCT04304235, https://clinicaltrials.gov/ct2/show/NCT04304235. Registered 11 March 2020.
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