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 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).

Implementation of Smart Triage combined with a quality improvement program for children presenting to facilities in Kenya and Uganda: An interrupted time series analysis

“…Based on the feasibility study (22), the increase in the proportion of children receiving a bundle of care within one hour in this study was 21.4%, and the proportion of children receiving IVA was 8.2%. Based on these observations, we estimated that using an alpha of .05, at a power of 80%, we would require 10 600 triages (1290 treatments) in the pre-intervention and post-intervention phases combined, to confirm this effect observed in the previous study.…”

“…Qualitative interviews were used to optimize the platform (21). A cost-effectiveness study was completed to determine utilization costs and implications for scale-up (22).…”

“…We have developed, validated, implemented, and evaluated a digital triage platform called Smart Triage (18)(19)(20)(21)(22). The Smart Triage platform comprises data-driven risk assessment (triage), patient and treatment tracking, a real-time dashboard, and automated reports to improve emergency case recognition and time-to-treatment.…”