Improving early infant diagnosis for HIV-exposed infants using unmanned aerial vehicles for blood sample transportation in Conakry, Guinea: a comparative cost-effectiveness analysis

Background: 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. Methods and findings: 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$1194. Conclusion: 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

Improving early infant diagnosis for HIV-exposed infants using unmanned aerial vehicles versus motorcycles for blood sample in Conakry, Guinea: a comparative cost-effectiveness analysis.

Background 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. Methods and Findings We conducted a cost-effectiveness comparative analysis between EID blood samples transportation by UAV compared to motorcycle using Monte Carlo simulations. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed with local annual GDP per capita (US$1,194) set as the threshold. Simulation models included parameters such as consultation timing (e.g. time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Sensitivity analyses were conducted. Over a 5-year program and 778 HIV-exposed infants seen in consultation on average every year, the UAV transport strategy was able to save 49.6 life-years [90$12.4 [10.2 –14.6] per infant tested compared to the motorcycle one. With an ICER of $979 per life-year gained, the UAV transportation strategy was below the cost-effectiveness threshold. The ICER is primarily sensitive to weather-related downtime, UAV loss risk, number of HIV-infected infants and travel time saved by UAV. Conclusion The transportation of EID blood samples by UAVs in Conakry was found to be cost effective in that context. EID blood samples transportation by UAV could be a cost-effective strategy in other countries with traffic congestion and low rate of EID