Cost-Effectiveness of Aerial Logistics for Maternal and Newborn Health: A Simulation-Based Analysis Grounded in Real-World Evidence from the Ashanti Region in Ghana

Abstract

Background: In sub-Saharan Africa, low antenatal care (ANC) coverage and limited access to facility-based deliveries remain key drivers of adverse maternal and newborn health (MNH) outcomes. Inadequate service provision at health facilities and insufficient care-seeking behavior are exacerbated by supply chain inefficiencies that restrict access to essential maternal health commodities. Aerial logistics (centralized storage and drone delivery) has shown promise as a novel approach to addressing these logistical challenges and supporting maternal health service delivery, but its cost-effectiveness has not been evaluated. Objectives: This study evaluates the cost-effectiveness of aerial logistics as an intervention for MNH. It builds on previously observed programmatic effects (increases in ANC visits, facility-based deliveries, and reductions in maternal mortality in Ghana’s Ashanti Region) to model downstream health outcomes and estimate incremental economic value. Methods: Using microsimulation and published epidemiological parameters, the study models additional health outcomes resulting from increased service utilization among 11 249 pregnant women, including reductions in low birth weight, postpartum hemorrhage, neonatal mortality, and early-onset neonatal sepsis. Alongside the observed maternal mortality reduction, all outcomes are translated into life-years saved and discounted disability-adjusted life-years (DALYs) averted. Cost estimates are based on real-world aerial logistics operations and national data on health system expenditures and household out-of-pocket costs. Incremental cost-effectiveness ratios (ICERs) are calculated from both health system and societal perspectives. Uncertainty is addressed through one-way and probabilistic sensitivity analyses. Results: The intervention averted 3754.99 discounted DALYs at a net cost of US $400 987 from the government perspective, yielding an ICER of US $106.79 per DALY averted. From the societal perspective, the ICER was US $377.82. The cost per premature death averted was US $3072.87. Service utilization ICERs included US $88.46 per additional ANC user, US $2.24 per ANC visit, and US $5.60 per facility-based delivery. All estimates remained below national cost-effectiveness thresholds across sensitivity analyses. Discussion: Aerial logistics yields substantial health and economic gains, derived from previously documented increases in service utilization, and ranks among the most cost-effective documented MNH interventions. Conclusions: Aerial logistics is a highly cost-effective, scalable strategy to improve maternal and newborn health in resource-limited settings.