Cost-effectiveness Analysis of the PUSH Model for Health-commodity Supply-chain Management in Couffo Department, Benin

Abstract

<i>Introduction</i><i>.</i> In resource-limited countries, the performance of health-commodity supply chains is a critical determinant of access to care. Despite the documented operational advantages of the PUSH logistics model (push-based flow), its comparative economic assessment against the traditional PULL model (pull-based flow) remains limited, depriving decision-makers of robust evidence for optimal investment choices. <i>Methods</i>. A retrospective differential cost-effectiveness analysis was conducted over six months in Couffo Department, Benin. Two comparable health zones applying respectively the PULL model (ADD zone) and the PUSH model (KTL zone) provided a quasi-experimental framework. Direct, indirect and opportunity logistics costs were micro-costed for 32 health centres. The primary outcome was measured by the availability rate of essential commodities. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses tested the robustness of the results. <i>Results</i><i>.</i> The PUSH model reduced total logistics costs by 87.8% compared with the PULL model, driven by substantial transport optimisation (a 77% reduction in cost per kilometre) and the near-elimination of economic losses associated with stock-outs (USD 7,333 saved). Concurrently, it improved product availability from 94.16% to 98.80%, shortened delivery lead times, and increased stakeholder satisfaction. The ICER for availability was negative (-USD 0.40 per percentage point gained), confirming that PUSH is a dominant strategy (less costly and more effective). This conclusion remained robust across all sensitivity-analysis scenarios. <i>Conclusion</i><i>.</i> This study provides empirical evidence that the PUSH model is economically dominant over the PULL model in the Beninese context. Its large-scale deployment represents a high-return strategic investment, enabling optimal resource allocation to strengthen health-system resilience and progress towards universal health coverage.