Cost-effectiveness analysis protocol of the Smart Triage program: A point-of-care digital triage platform for pediatric sepsis in Eastern Uganda.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
28
06
2021
accepted:
01
11
2021
entrez:
17
11
2021
pubmed:
18
11
2021
medline:
30
12
2021
Statut:
epublish
Résumé
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.
Sections du résumé
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.
Identifiants
pubmed: 34788338
doi: 10.1371/journal.pone.0260044
pii: PONE-D-21-21174
pmc: PMC8598020
doi:
Banques de données
ClinicalTrials.gov
['NCT04304235']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0260044Subventions
Organisme : Wellcome Trust
ID : 215695/B/19/Z
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Lancet Glob Health. 2018 Feb;6(2):e152-e168
pubmed: 29248365
BMC Health Serv Res. 2020 Jun 3;20(1):493
pubmed: 32493319
PLoS One. 2021 Jun 10;16(6):e0253051
pubmed: 34111209
Glob Health Action. 2016 Feb 17;9:29417
pubmed: 26899774
J Crit Care. 2015 Aug;30(4):861.e9-14
pubmed: 25956595
PLoS One. 2016 Jan 04;11(1):e0145043
pubmed: 26727369
Lancet. 2020 Jan 18;395(10219):200-211
pubmed: 31954465
Shock. 2017 Jul;48(1):29-35
pubmed: 28114166
Value Health. 2005 Sep-Oct;8(5):521-33
pubmed: 16176491
BMJ. 2002 Oct 19;325(7369):891-4
pubmed: 12386045
Intensive Care Med. 2014 Feb;40(2):182-91
pubmed: 24146003
Bull World Health Organ. 2015 Feb 1;93(2):118-24
pubmed: 25883405
Crit Care Med. 2019 Oct;47(10):1371-1379
pubmed: 31306176
BMC Health Serv Res. 2017 Apr 7;17(1):256
pubmed: 28388951
Crit Care Med. 1996 May;24(5):743-52
pubmed: 8706448
JAMA. 2018 Jul 24;320(4):358-367
pubmed: 30043064
Bull World Health Organ. 2006 Apr;84(4):314-9
pubmed: 16628305
Trop Med Int Health. 2010 Aug;15(8):964-72
pubmed: 20636527
BMC Pediatr. 2017 Jan 26;17(1):37
pubmed: 28122537
Intensive Care Med. 2020 Feb;46(Suppl 1):10-67
pubmed: 32030529
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
PLoS One. 2018 Mar 16;13(3):e0194187
pubmed: 29547624
Pediatrics. 2012 Sep;130(3):e676-82
pubmed: 22891229
JAMA Pediatr. 2019 Apr 1;173(4):352-362
pubmed: 30742207
PLoS Med. 2012;9(6):e1001238
pubmed: 22719233