Cost-effectiveness evaluation of neonatal emergency transport organization in Italy

Global pediatrics Pub Date : 2025-01-07 DOI:10.1016/j.gpeds.2025.100243

Carlo Bellini , Maurizio Gente , Diego Minghetti , Luca A. Ramenghi

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Abstract

Objective

The aim of this study was to evaluate the cost-effectiveness of the Italian Neonatal Emergency Transport Service (NETS), to analyse its current organisation and to identify potential financial benefits from improvements.

Methods

Using data from the 2023 national NETS survey conducted by the Italian Society of Neonatology, regional cost-effectiveness of operating the system were calculated. These were compared with ideal costs for on-call and dedicated NETS models, based on a previously established methodology.

Results

The total cost of operating NETS in Italy was €32,785,650. Of this, €24,964,050 was associated with services organised according to the on-call model, while €7,821,600 was associated with dedicated services. The cost per transport varied considerably between regions. The national median cost for on-call services was €7,386 (ranging from €1,809 to €76,209), while the national median cost for dedicated services was €2,421 (ranging from €2,073 to €2,770). The actual total cost could be reduced to the ideal cost of €15,304,308, with the ideal cost per individual transport being €2,450 for on-call services and €2,250 for dedicated services (compared to the current medians of €7,386 and €2,421, respectively).

Conclusions

The study concluded that the Italian NETS organisation is expensive and unsustainable due to limited financial resources, and requires a complete overhaul. The implementation of a more cost-effective 'hub-and-spoke' NETS network system could significantly improve financial sustainability. The findings suggest that improvements to the NETS organisation are needed not only in Italy, but potentially across Europe.

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