Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda.

Publication date: Aug 31, 2023

Sepsis, characterized by organ dysfunction due to presumed or proven infection, has a case-fatality over 20% in severe cases in low-and-middle income countries. Early diagnosis and treatment have proven benefits, prompting our implementation of Smart Triage at Jinja Regional Referral Hospital in Uganda, a program that expedites treatment through a data-driven triage platform. We conducted a cost-effectiveness analysis of Smart Triage to explore its impact on patients and inform multicenter scale up. The parent clinical trial for Smart Triage was pre-post in design, using the proportion of children receiving sepsis treatment within one hour as the primary outcome, a measure linked to mortality benefit in existing literature. We used a decision-analytic model with Monte Carlo simulation to calculate the cost per year-of-life-lost (YLL) averted of Smart Triage from societal, government, and patient perspectives. Healthcare utilization and lost work for seven days post-discharge were translated into costs and productivity losses via secondary linkage data. In 2021 United States dollars, Smart Triage requires an annuitized program cost of only $0. 05 per child, but results in $15. 32 saved per YLL averted. At a willingness-to-pay threshold of only $3 per YLL averted, well below published cost-effectiveness threshold estimates for Uganda, Smart Triage approaches 100% probability of cost-effectiveness over the baseline manual triage system. This cost-effectiveness was observed from societal, government, and patient perspectives. The cost-effectiveness observed was driven by a reduction in admission that, while explainable by an improved triage mechanism, may also be partially attributable to changes in healthcare utilization influenced by the coronavirus pandemic. However, Smart Triage remains cost-effective in sensitivity analyses introducing a penalty factor of up to 50% in the reduction in admission. Smart Triage’s ability to both save costs and avert YLLs indicates that patients benefit both economically and clinically, while its high probability of cost-effectiveness strongly supports multicenter scale up. Areas for further research include the incorporation of years lived with disability when sepsis disability weights in low-resource settings become available and analyzing budget impact during multicenter scale up. NCT04304235 (registered on 11/03/2020, clinicaltrials. gov).

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Concepts Keywords
Coronavirus Cost-effectiveness analysis
Hospital Economic evaluation
Nct04304235 Low-middle income country
Productivity Pediatric sepsis


Type Source Name
disease VO effectiveness
disease MESH sepsis
disease VO organ
disease MESH infection
disease VO effective
disease IDO country
pathway REACTOME Reproduction
disease MESH Sepsis syndrome
disease MESH death
disease VO population
drug DRUGBANK Oxygen
disease MESH Emergency
drug DRUGBANK Etoperidone
disease VO organization
drug DRUGBANK Tretamine
drug DRUGBANK Trestolone
disease VO monthly
disease IDO process
drug DRUGBANK Coenzyme M
disease IDO intervention
disease VO protocol
disease VO vaccine
disease MESH pneumonia
disease IDO facility
disease MESH uncertainty
disease MESH Malnutrition
disease IDO immunodeficiency
disease MESH Stunting
disease VO time
drug DRUGBANK Fenamole
drug DRUGBANK Ilex paraguariensis leaf
disease IDO symptom
disease IDO algorithm
disease MESH etiology
disease IDO quality
disease IDO site
disease VO Canada
disease MESH septic shock
disease MESH Neonatal sepsis
disease MESH infectious diseases
drug DRUGBANK Gold
disease MESH contraindications

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