Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States
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Authors
Delgado, M. KitStaudenmayer, Kristan L.
Wang, N Ewen.
Spain, David A.
Weir, Sharada G.
Owens, Douglas K.
Goldhaber-Fiebert, Jeremy D.
UMass Chan Affiliations
Center for Health Policy and ResearchDocument Type
Journal ArticlePublication Date
2013-10-01Keywords
AdolescentAdult
Aged
Aged, 80 and over
Air Ambulances
Ambulances
Cost-Benefit Analysis
Female
Health Care Costs
Humans
Injury Severity Score
Male
Middle Aged
Models, Theoretical
Quality-Adjusted Life Years
United States
Wounds and Injuries
Young Adult
Emergency Medicine
Health Services Administration
Health Services Research
Trauma
Metadata
Show full item recordAbstract
STUDY OBJECTIVE: We determine the minimum mortality reduction that helicopter emergency medical services (EMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of patients with minor injury. METHODS: We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective during a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality-adjusted life-year gained compared with ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma, National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. RESULTS: Helicopter EMS must provide a minimum of a 15% relative risk reduction in mortality (1.3 lives saved/100 patients with the mean characteristics of the National Study on the Costs and Outcomes of Trauma cohort) to cost less than $100,000 per quality-adjusted life-year gained and a reduction of at least 30% (3.3 lives saved/100 patients) to cost less than $50,000 per quality-adjusted life-year. Helicopter EMS becomes more cost-effective with significant reductions in patients with minor injury who are triaged to air transport or if long-term disability outcomes are improved. CONCLUSION: Helicopter EMS needs to provide at least a 15% mortality reduction or a measurable improvement in long-term disability to compare favorably with other interventions considered cost-effective. Given current evidence, it is not clear that helicopter EMS achieves this mortality or disability reduction. Reducing overtriage of patients with minor injury to helicopter EMS would improve its cost-effectiveness. Inc. All rights reserved.Source
Ann Emerg Med. 2013 Oct;62(4):351-364.e19. doi: 10.1016/j.annemergmed.2013.02.025. Epub 2013 Apr 9. Link to article on publisher's siteDOI
10.1016/j.annemergmed.2013.02.025Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30475PubMed ID
23582619Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.annemergmed.2013.02.025