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Trop Med Int Health. 2011 Sep;16(9):1151-8. doi: 10.1111/j.1365-3156.2011.02819.x. Epub 2011 Jun 21.

Ambulance service within a comprehensive intervention for reproductive health in remote settings: a cost-effective intervention.

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Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.



To assess the cost-effectiveness of an ambulance service within a comprehensive hospital/community-based program aimed at improving access and quality of reproductive health in poor-resources settings.


Obstetrical cases referred to the hospital with the ambulance during a 3-month period were prospectively recorded. Clinical indications were used to determine the effectiveness of the referral; the direct costs of the service were calculated. Overall effectiveness was then measured against WHO thresholds.


Ninety-two obstetrical referrals were recorded. Eleven (12%) were considered effective, corresponding to 611.7 years saved. Cost per year saved was 15.82 US dollars which about half of WHO's 30 US dollar benchmark defining very attractive interventions. Sensitivity analyses on the costs of the ambulance and the rate of effective referrals emphasized the robustness of the result.


The cost-effectiveness profile of an ambulance service within a series of interventions aimed at improving reproductive health in remote settings is very attractive.

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