Abstract
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. 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. 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 of parent clinical trial: NCT04304235, https://clinicaltrials.gov/ct2/show/NCT04304235. Registered 11 March 2020.
Highlights
Sepsis is a syndrome characterized by an inflammatory state resulting from a presumed or proven infection that results in organ dysfunction and/or death [1], with global disease-specific mortality of 20% and a case fatality ratio of 25% or higher in low-middle income countries (LMICs) [2,3]
While high-income countries have employed evidence-based patient triage strategies to expedite sepsis treatment [6], these strategies involve various laboratory investigations rarely available in LMIC settings, where delays in treatment leading to a high case fatality ratio are commonplace [7]
The results of the Monte Carlo simulation will be presented on a cost-effectiveness plane, in order to illustrate the percentage of simulations that result in added effectiveness for an added cost. We will summarize these results on a cost-effectiveness acceptability curve, which will illustrate the confidence of Smart Triage being cost-effective at different thresholds of willingness to pay per years-of-life lost (YLL)-averted
Summary
Sepsis is a syndrome characterized by an inflammatory state resulting from a presumed or proven infection that results in organ dysfunction and/or death [1], with global disease-specific mortality of 20% and a case fatality ratio of 25% or higher in low-middle income countries (LMICs) [2,3]. While high-income countries have employed evidence-based patient triage strategies to expedite sepsis treatment [6], these strategies involve various laboratory investigations rarely available in LMIC settings, where delays in treatment leading to a high case fatality ratio are commonplace [7]. 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. To complement the ongoing Smart Triage interventional trial, we propose methods for a concurrent cost-effectiveness analysis of the Smart Triage platform
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