Evaluation of neonatal transport in a European country shows that regional provision is not cost-effective or sustainable and needs to be re-organised

Aim: There are three dedicated and 41 on-call neonatal emergency transport services (NETS) in Italy, and activity levels vary dramatically. We examined the cost-effectiveness of a hub-and-spoke NETS by looking at the costs and activity levels in the Liguria region and established the financial needs for improving NETS across Italy. Methods: The cost of running NETS in the Liguria region from 2012 to 2015 was evaluated and analysed, and three different models determined the transports needed each year to provide the best organisational model. Results: The average number of NETS transports in the Liguria region during the study period was 234, and the models indicated that 200–350 transports per year were the optimal amount of activity that was needed to achieve good financial performance and for the personnel to acquire a suitable skill set. Only five of the 41 on-call Italian NETS and the three dedicated services carried out more than 200 transports a year. Of the rest, 26 carried out up to 100 and 10 carried out 101–200. Conclusion: Italian NETS, which are managed on the basis of regional decisional autonomy, are expensive and no longer sustainable in this era of limited financial resources. A complete overhaul is urgently needed.