Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France.
BMJ Glob Health. 2023 Nov;8(11). doi: 10.1136/bmjgh-2023-012522.
Early infant diagnosis (EID) for HIV-exposed infants is essential due to high mortality during the first months of their lives. In Conakry (Guinea), timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness of transporting EID blood samples by unmanned aerial vehicles (UAV), also known as drones.
Using Monte Carlo simulations, we conducted a cost-effectiveness comparative analysis between EID blood samples transportation by on-demand UAV transportation versus the baseline scenario (ie, van with irregular collection schedules) and compared with a hypothetic on-demand motorcycle transportation system. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed. Simulation models included parameters such as consultation timing (eg, time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Over the 5-year period programme, the UAV and motorcycle strategies were able to save a cumulative additional 834.8 life-years (585.1-1084.5) and 794.7 life-years (550.3-1039.0), respectively, compared with the baseline scenario. The ICER per life-year gained found were US$535 for the UAV strategy versus baseline scenario, US$504 for the motorcycle strategy versus baseline scenario and US$1137 per additional life-year gained for the UAV versus motorcycle strategy. Respectively, those ICERs represented 44.8%, 42.2% and 95.2% of the national gross domestic product (GDP) per capita in Guinea-that is, US$1194.
Compared with the baseline strategy, both transportation of EID blood samples by UAVs or motorcycles had a cost per additional life-year gained below half of the national GDP per capita and could be seen as cost-effective in Conakry. A UAV strategy can save more lives than a motorcycle one although the cost needed per additional life-year gained might need to consider alongside budget impact and feasibility considerations.
由于婴儿在生命的头几个月死亡率很高，对艾滋病毒暴露婴儿进行早期婴儿诊断（EID）至关重要。在科纳克里（几内亚），由于交通拥堵阻碍了血液样本快速运往中央实验室，及时进行 EID 非常困难。我们调查了使用无人驾驶飞行器（UAV）（也称为无人机）运输 EID 血液样本的成本效益，这种方法也称为无人机。
使用蒙特卡罗模拟，我们对通过按需 UAV 运输与基线情况（即按不规则收集时间表的货车）相比，EID 血液样本运输的成本效益进行了比较分析，并与假设的按需摩托车运输系统进行了比较。计算了每获得一个生命年的增量成本效益比（ICER）。模拟模型包括咨询时间（例如到达时间）、摩托车和 UAV 特性、天气和交通状况等参数。在 5 年计划期间，与基线情况相比，UAV 和摩托车策略分别能够节省 834.8 个额外的生命年（585.1-1084.5）和 794.7 个生命年（550.3-1039.0）。与基线方案相比，UAV 策略获得的每个生命年的 ICER 为 535 美元，摩托车策略为 504 美元，UAV 与摩托车策略相比，每增加一个生命年的成本为 1137 美元。分别为，这些 ICER 分别代表几内亚人均国民生产总值（GDP）的 44.8%、42.2%和 95.2%，即 1194 美元。
与基线策略相比，通过 UAV 或摩托车运输 EID 血液样本的成本效益比每获得一个额外的生命年都低于几内亚人均 GDP 的一半，在科纳克里可能被视为具有成本效益。UAV 策略可以比摩托车策略拯救更多生命，尽管每获得一个额外生命年所需的成本可能需要考虑预算影响和可行性考虑因素。
