title: Ambulance service within a comprehensive intervention for reproductive health in remote settings: a cost-effective intervention.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The cost-effectiveness profile of an ambulance service within a series of interventions aimed at improving reproductive health in remote settings is very attractive.
authors.affiliation: Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy. dadosomigliana@yahoo.it
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.forename: Alice
authors.initials: A
authors.lastname: Sabino
authors.forename: Richard
authors.initials: R
authors.lastname: Nkurunziza
authors.forename: Emmy
authors.initials: E
authors.lastname: Okello
authors.forename: Gianluca
authors.initials: G
authors.lastname: Quaglio
authors.forename: Peter
authors.initials: P
authors.lastname: Lochoro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
mesh_terms: D000293:Adolescent; D000552:Ambulances / Q000191:economics* / Q000706:statistics & numerical data*; D003153:Community Health Services; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000592:standards*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D060728:Reproductive Health / Q000592:standards / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data*; D012424:Rural Population; D014454:Uganda; D014944:World Health Organization / Q000191:economics; D055815:Young Adult