Uncrewed aircraft systems for blood transport in Kenya: a facility location, utilization, and cost-efficiency analysis

Abstract Background Uncrewed aircraft systems (UAS) are increasingly promoted to improve access to blood and emergency medical commodities in low-and middle-income countries. However, economic evaluations have mostly focused on aircraft performance, with limited attention to base station placement, utilization, and staffing requirements – key determinants of unit cost given high fixed operating expenses. Moreover, blood and similar commodities can only be administered in facilities that are legally authorized and clinically equipped to manage severe adverse reactions, constraining effective demand. We evaluated how these factors would jointly affect the cost-efficiency of UAS blood transport in Kenya. Methods We conducted a facility location and economic analysis of UAS blood transport under three base station placement scenarios: existing blood bank sites, urban centers (> 30,000 population), and unrestricted village and town locations. We estimated geographic and population-weighted coverage of transfusing hospitals, compared UAS flight times with road travel times within identical service areas, and projected delivery volumes and unit costs using facility catchment populations, utilization assumptions, and staffing models consistent with 24/7 emergency operations. Results Across scenarios, three base stations covered 50% of transfusing hospitals and 60–81% of national blood demand when weighted by population. Seven stations would cover 75% of transfusing facilities, and 93% of population demand, beyond which marginal gains diminished sharply. Mean UAS delivery time was approximately one-third of road travel time, with the largest advantage observed in urban and peri-urban corridors – precisely where straight-line distance alone would suggest UAS offer limited benefit. Estimated annual base station costs were US$61,500 [95% CI $58,200: $106,000], of which staffing accounted for 59%-84% of costs. The estimated UAS transport costs per unit of whole blood transported was $7.59 [95% CI $5.4: $34.22], compared to $0.78[95% CI $0.63: $1.01] for road transport under our base assumptions of three units delivered per flight. Achieving complete geographic coverage would require approximately 28 stations, many operating at low utilization and high cost. Conclusions In Kenya, a small number of well-placed UAS base stations can achieve substantial gains in hospital access and delivery speed relative to road transport, particularly in dense urban and peri-urban corridors. UAS blood transport is most cost-efficient when concentrated in a limited number of high-utilization stations; staffing, rather than aircraft costs, dominates expenditure and explains why expansion into low-demand areas rapidly increases unit costs. These cost-efficiency findings should be weighed alongside access and equity value of UAS in remote areas, which this analysis does not capture.