Cost-Effectiveness Analysis of Helicopter EMS for Trauma Patients,☆☆

Presented in part at the American College of Emergency Physicians Research Forum, Cincinnati, OH, February 1996.
https://doi.org/10.1016/S0196-0644(97)70010-6Get rights and content

Abstract

Study objective: To evaluate the cost-effectiveness of helicopter EMS for trauma patients. Methods: We applied a cost-effectiveness analysis from the service provider's perspective to cost and effectiveness estimates. The cost estimates comprise direct operating costs and additional survivors' hospital costs. The effectiveness estimates were calculated with the TRISS methodology from literature sources and data from a cohort of patients transported by helicopter during 1994 and 1995. Sensitivity analysis and discounting were used. Cost per life saved and discounted cost per year of life in 1995 US dollars were the main outcome measures. Results: The reported literature survival benefit ranges from 1 to 12 additional survivors per 100 patients flown. Transport costs were $2,214 per patient, and each additional survivor's hospitalization averaged $15,883. For the base case (5 additional survivors per 100 patients flown), cost per life was $60,163 and discounted cost per year of life $2,454. Sensitivity analysis revealed that discounted cost per year of life could be as high as $9,677 or as low as $1,400 and that it was most dependent on the survival benefit. These results are comparable to a reported median discounted cost per year of life of $19,000 for other commonly used lifesaving medical interventions. Conclusion: Assuming that helicopter air medical transport provides a substantial survival benefit for trauma patients, our findings suggest that this service is a cost-effective option for the treatment of trauma patients. The magnitude of the survival benefit is the most important factor determining cost-effectiveness. [Gearhart PA, Wuerz R, Localio AR: Cost-effectiveness analysis of helicopter EMS for trauma patients. Ann Emerg Med October 1997;30:500-506.]

Section snippets

INTRODUCTION

Trauma is a major public health concern in the United States. Often affecting the young, trauma can result in significant health care expenditures, lost wages, and disability.1 Trauma care systems, although expensive, save many years of life and enable many trauma victims to return to the workplace.2 For more than 25 years, helicopter ambulances have been a part of organized trauma systems in the United States. Helicopter programs were estimated to cost $250 million in 1991,3 but no formal

MATERIALS AND METHODS

We estimated cost-effectiveness using commonly accepted standards.4, 5, 6 Trauma was chosen because it is the most well-accepted indication for helicopter transport,7 and the service provider's perspective was used. The larger societal perspective was not used because data on lost wages and long-term disability attributable to trauma are difficult to estimate. Also, “costs,” as represented by the amount charged to patients and insurers, seldom reflect the actual costs of providing the service.

RESULTS

The direct operating costs totaled $2,253,952 per year, as follows: $1,197,115 (53%) personnel, $491,081 (22%) capital, $296,796 (13%) operations, $134,942 (6%) insurance, $118,332 (5%) administration, and $15,685 (<1%) medical supplies. The total number of helicopter transports in 1995 was 1,018, which yielded an average cost per patient transport of $2,214. The expected hospital reimbursement for a trauma survivor (used to estimate hospital costs) averaged $15,883 (range, $2,722 to $64,526).

DISCUSSION

The findings of this analysis of helicopter air medical programs for trauma patients contradict the widely held perception that these programs are not cost-effective. It is tempting to equate low costs with cost-effectiveness (and high costs with cost-prohibitiveness); however, an explicit cost-effectiveness study can avert false conclusions. For example, thrombolytic treatment with tissue plasminogen activator in acute myocardial infarction has a survival benefit of a magnitude similar to that

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      Expressed as lives saved per 100 dispatches, HEMS assistance results in an average of 5.33 lives saved per 100 HEMS dispatches for severely injured patients. In the literature, the number of lives saved per 100 HEMS dispatches has been reported to range from 1.1 to 19 [5,13,15,23]. Because of the great variety in study design, geographical settings (rural versus urban), organisation of the trauma systems, type of pre-hospital trauma care (physician, nurse, EMS, HEMS), study population (blunt versus penetrating trauma), and definition of mortality (i.e., in-hospital mortality or mortality in a specific time frame), it is difficult to compare our results with previously published international studies.

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    From the College of Medicine,* the Center for Emergency Medical Services, and the Center for Biostatistics and Epidemiology,§ Pennsylvania State University College of Medicine, Hershey, PA.

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