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% PI: -1.3 –100.5]. The UAV strategy costs an additional of $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.