Assessing the Complexity of Economic Scenarios and Decision-Making Processes for Interfacility Neonatal Transport:...

Interfacility transports from lower-level health care facilities to specialized centers support regionalization of care and improve morbidity and mortality rates. We assessed the published literature related to neonatal transport costs and characterized the clinical and economic complexities of risk-based decision-making to inform health policy options.

We conducted a targeted scoping review of published ground and air transport literature reporting on cost-related outcomes with a focus on neonatal studies. We converted estimates to 2020 US dollars. We summarized methods, findings, and limitations of existing studies. From the perspectives of various stakeholders involved in complex transfer and transportation decisions, we provided simplified estimates of stakeholder cost scenarios and graphical representations of basic microeconomic concepts associated with transport.

Eight cost-related neonatal transport studies were identified from different countries. The average estimated cost of ground transport was approximately $5,043 and $18,000 for air transport. Most cost-related studies used the perspective of the referring or accepting hospital, but not both. There were no randomized or experimental intervention studies. The literature suggests that the greatest portion of the costs incurred for transfers was for interhospital transports. Our simplified estimates illustrate trade-offs among distinct stakeholders for transport decisions.

Interfacility transport decisions involve time-sensitive and complex processes affecting multiple stakeholders, with many variables beyond cost. Few studies report cost outcomes for neonatal transports, with identified studies varying by country-level health care systems, populations analyzed, study designs, and cost estimation methods. Improving the transport decision-making process may reduce patient risk and transport cost. Other strategies include expanding telehealth programs, improving communication among medical providers, strengthening specialist capacity at referring hospitals, and tailoring risk-based planning before delivery.