A cost-effectiveness assessment of an ambulance-based referral system for emergencies: the case of Beira, Mozambique

Giacomo Buzzao (), Francesco Rullani (), Giovanni Putoto () and Marcello Mazzotta ()
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Giacomo Buzzao: Dept. of Management, Venice School of Management, Yunus Social Business Centre, Università Ca' Foscari Venice
Francesco Rullani: Dept. of Management, Venice School of Management, Yunus Social Business Centre, Università Ca' Foscari Venice
Giovanni Putoto: Doctors with Africa, CUAMM
Marcello Mazzotta: Doctors with Africa, CUAMM

No 2, Working Papers from Venice School of Management - Department of Management, Università Ca' Foscari Venezia

Abstract: We set out to estimate the cost-effectiveness of an ambulance-based referral system for emergencies, connecting primary care health centres to a central hospital in a sub-Saharan low-income context. We adopted an observational retrospective study design in the setting of the Beira District (Sofala Region, Mozambique) and classified effective referrals based on the triage emergency codes assigned during transfer. We focused solely on referral running costs required to run the ambulance and complete safe and effective transfer, including staff (nurses and drivers) and communication costs between health centres, ambulance operators and the central hospital. A total of 7849 referrals were included in the analysis, 6295 of which were deemed effective. The total running cost of the intervention (11 months) was $172.071. The cost-per-effective referral was $27,33, which is below the acceptability benchmarks that can be considered “very attractive” ($58,20) and that we defined as 1/10 of the national GDP per capita of Mozambique ($582). Sensitivity analysis corroborates our findings, which confirm and extend previous evidence on the high cost-effectiveness of ambulance-based referral systems for emergencies in sub-Saharan low-income countries.

Pages: 23 pages
Date: 2024-04
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