OBJECTIVES:

Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill, and have several advantages compared to ground ambulance units. Since the unit cost of HEMS is higher than traditional ground-based Emergency Medical Services (EMS), it is important to further investigate the impact of HEMS and asses the conditions that would allow for the optimization of these services. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared to Advanced Life Support (ALS) ambulance-based EMS under current practices and in developed scenarios with various improvements in patient selection and aviation performance.

METHODS:

Incremental cost-effectiveness ratio (ICER) was evaluated using the differences in outcomes and costs between HEMS and ambulance-based EMS. Estimated mortality within 30 days, and quality-adjusted life-years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale derived from the literature, and a one-way sensitivity analysis was conducted to the QALY-indexes ranging from 0,6 to 0,8 in different patient groups. Survival rates were calculated for different patient groups according to the national HEMS quality registry. The cost-structure of national HEMS operator of Finland (FinnHEMS) was evaluated according to the financial statements and was estimated to be 48 million euros.

RESULTS:

Under current operative practices, HEMS was estimated to prevent the 30-day mortality of 68,1 patients, with an ICER of 43,688-56,918€/QALY. By including stroke patients in dispatch criteria, the cost-effectiveness can be significantly improved. This means obtaining approximately 665 additional QALYs per year, with an ICER ranging from 25,000-33,000€/QALY.

CONCLUSIONS:

This study’s results of cost-effectiveness suggest that HEMS operations are acceptable from a societal willingness-to-pay perspective. The cost-effectiveness of Finnish HEMS can be best improved by including new patient groups, as the overall costs are fixed (94%) and costs are determined based on the utilization of capacity.