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

Abstract Background 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 Refe...

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Main Authors: Edmond C. K. Li, Abner Tagoola, Clare Komugisha, Annette Mary Nabweteme, Yashodani Pillay, J. Mark Ansermino, Asif R. Khowaja
Format: Article
Language:English
Published: BMC 2023-08-01
Series:BMC Health Services Research
Subjects:
Online Access:https://doi.org/10.1186/s12913-023-09977-5
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author Edmond C. K. Li
Abner Tagoola
Clare Komugisha
Annette Mary Nabweteme
Yashodani Pillay
J. Mark Ansermino
Asif R. Khowaja
author_facet Edmond C. K. Li
Abner Tagoola
Clare Komugisha
Annette Mary Nabweteme
Yashodani Pillay
J. Mark Ansermino
Asif R. Khowaja
author_sort Edmond C. K. Li
collection DOAJ
description Abstract Background 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. Methods 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. Results 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. Conclusion 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. Trial registration NCT04304235 (registered on 11/03/2020, clinicaltrials.gov).
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spelling doaj.art-11d9c561dcf0490e91f21c2ac7c338912023-11-26T12:42:48ZengBMCBMC Health Services Research1472-69632023-08-0123111510.1186/s12913-023-09977-5Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern UgandaEdmond C. K. Li0Abner Tagoola1Clare Komugisha2Annette Mary Nabweteme3Yashodani Pillay4J. Mark Ansermino5Asif R. Khowaja6Department of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaJinja Regional Referral HospitalWorld Alliance for Lung and Intensive Care Medicine in UgandaWorld Alliance for Lung and Intensive Care Medicine in UgandaDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaFaculty of Applied Health Sciences, Brock UniversityAbstract Background 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. Methods 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. Results 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. Conclusion 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. Trial registration NCT04304235 (registered on 11/03/2020, clinicaltrials.gov).https://doi.org/10.1186/s12913-023-09977-5Cost-effectiveness analysisEconomic evaluationPediatric sepsisTriageLow-middle income countrySepsis
spellingShingle Edmond C. K. Li
Abner Tagoola
Clare Komugisha
Annette Mary Nabweteme
Yashodani Pillay
J. Mark Ansermino
Asif R. Khowaja
Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda
BMC Health Services Research
Cost-effectiveness analysis
Economic evaluation
Pediatric sepsis
Triage
Low-middle income country
Sepsis
title Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda
title_full Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda
title_fullStr Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda
title_full_unstemmed Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda
title_short Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda
title_sort cost effectiveness analysis of smart triage a data driven pediatric sepsis triage platform in eastern uganda
topic Cost-effectiveness analysis
Economic evaluation
Pediatric sepsis
Triage
Low-middle income country
Sepsis
url https://doi.org/10.1186/s12913-023-09977-5
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