OBJECTIVES: Many patients suffer from acute stroke at a significant distance from dedicated stroke centers. Since onset of advanced stroke care is time critical, the impact of rapid transport provided by helicopter emergency medical services (HEMS) on patient outcome merits further evaluation. Accordingly, the aim of this study was to evaluate the cost-effectiveness of a HEMS compared with ground-based ambulance-transport for patients with acute stroke to a stroke unit (SU).

METHODS: A Markov-model was developed based on the modified Ranking Scale (mRS) states 90 days after stroke to simulate consequences over a 10-year time-horizon. Consequences include recurrent stroke, deteriorated mRS, death due to recurrent stroke or other reasons. Health benefits were measured in quality-adjusted life-years (QALYs) and life-years (LYs). Probabilities were derived from the literature mainly the stroke registry. According to data derived from the OEAMTC Air Rescue, 4.9% of all SU admissions are carried out by HEMS. The target value for an appropriate use of HEMS was assumed to be 20%. The assumption was because 18% of all patients admitted to a SU suffer a severe stroke (NIH-SS<13). Direct-costs (2020€) were derived from published sources from the payer’s perspective. QALYs, LYs and costs were discounted. Monte-Carlo-simulation accounted for uncertainty.

RESULTS: A >20% proportion of stroke patients who were transported by HEMS to a SU is associated with savings over a 10-year time-horizon (3,500.- € to 10,191.- € per patient). Savings are due to a better neurological status (mRS after 90 days), because of the faster onset of stroke interventions. Patients also achieved a higher life expectancy (0.7 to 1.39 LYs) and quality of life [0.23 to 0.86 QALYs).

CONCLUSIONS: In the entire cohort of stroke patients in 2020 (n=12,953), savings of 45.3 million euros could be achieved. 1€ spend in HEMS results in savings of 15.9.- € in the health-care and social system.