School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2021 Nov 17;16(11):e0260044. doi: 10.1371/journal.pone.0260044. eCollection 2021.
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.
败血症是一种临床综合征，其特征是由于疑似或确诊的感染导致器官功能障碍。在中低收入国家，严重病例的病死率可能高达 25%或更高，但早期诊断和及时治疗已被证明有益。乌干达金贾地区转诊医院的 Smart Triage 项目将通过数据驱动的电子患者分诊系统为儿童提供快速败血症治疗。为了补充正在进行的 Smart Triage 干预试验，我们提出了一种用于 Smart Triage 平台的同时成本效益分析方法。
我们将采用一种基于社会视角的决策分析模型，结合政府和自付费用，因为由于缺乏全民健康覆盖，乌干达的患者承担了相当一部分医疗费用。我们将使用先前发表的二级数据，将医疗保健利用与成本以及中间结果与死亡率联系起来。我们将通过概率敏感性分析来模拟不确定性，并使用成本效益接受性曲线在各种意愿支付阈值下呈现结果。
我们提出的分析代表了评估创新数字分诊平台成本效益的第一步，该平台旨在通过加快资源匮乏环境中儿科败血症的护理来改善临床结局。我们使用决策分析模型将二级成本数据联系起来，纳入出院后医疗保健利用情况，并对临床终点进行建模，这在中低收入国家的儿科败血症分诊文献中也是新颖的。我们的分析，以及随后分析的预算影响和扩大规模分析，将为 Smart Triage 平台的未来修改提供信息，并推动该平台在区和国家层面的扩大。
母临床试验的试验注册：NCT04304235，https://clinicaltrials.gov/ct2/show/NCT04304235。注册于 2020 年 3 月 11 日。
