Article Text

Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
  1. Richard Lilford1,
  2. Dmitri Nepogodiev1,
  3. Peter J Chilton1,
  4. Samuel I Watson1,
  5. Darius Erlangga2,
  6. Peter Diggle3,
  7. Alan J Girling1,
  8. Mark Sculpher4
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Lancaster Medical School, Lancaster University, Lancaster, UK
  4. 4Centre for Health Economics, University of York, York, UK
  1. Correspondence to Professor Richard Lilford; R.J.LILFORD{at}


A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore carried out an analysis of issues that are of particular salience to this important topic. This is an intellectual study in which we develop models, identify their limitations, suggest potential extensions to the models and discuss priorities for empirical studies to populate models. First, we develop a general model to calculate changes in survival contingent on the reduced time to treatment that an emergency transport system is designed to achieve. Second, we develop a model to estimate transfer times over an area that will be served by a proposed transfer system. Third, we discuss difficulties in obtaining parameters with which to populate the models. Fourth, we discuss costs, both direct and indirect, of an emergency transfer service. Fifth, we discuss the issue that outcomes other than survival should be considered and that the effects of a service are a weighted sum over all the conditions and severities for which the service caters. Lastly, based on the above work, we identify priorities for research. To our knowledge, this is the first study to identify and frame issues in the health economics of acute transfer systems and to develop models to calculate survival rates from basic parameters, such as time delay/survival relationships, that vary by intervention type and context.

  • health economics

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  • Handling editor Lei Si

  • Contributors The initial draft was written by RL, DN, PJC and DE. Statistical support was provided by SIW, PD, AJG and MS. All authors contributed to revisions of the manuscript All authors read and approved the submitted manuscript.

  • Funding RL and PJC were funded by the National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands. RL and DN were also funded by the NIHR Global Health Research Units on Global Surgery and Improving Health in Slums using UK aid from the UK Government to support health research.

  • Disclaimer This paper presents independent research and the views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article, or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.