Cost-effectiveness and quality-of-life analysis of physician-staffed helicopter emergency medical services

Br J Surg. 2009 Nov;96(11):1365-70. doi: 10.1002/bjs.6720.


Background: The long-term health outcomes and costs of helicopter emergency medical services (HEMS) assistance remain uncertain. The aim of this study was to investigate the cost-effectiveness of HEMS assistance compared with emergency medical services (EMS).

Methods: A prospective cohort study was performed at a level I trauma centre. Quality-of-life measurements were obtained at 2 years after trauma, using the EuroQol-Five Dimensions (EQ-5D) as generic measure to determine health status. Health outcomes and costs were combined into costs per quality-adjusted life year (QALY).

Results: The study population receiving HEMS assistance was more severely injured than that receiving EMS assistance only. Over the 4-year study interval, HEMS assistance saved a total of 29 additional lives. No statistically significant differences in quality of life were found between assistance with HEMS or with EMS. Two years after trauma the mean EQ-5D utility score was 0.70 versus 0.71 respectively. The incremental cost-effectiveness ratio for HEMS versus EMS was 28,327 Euro per QALY. The sensitivity analysis showed a cost-effectiveness ratio between 16,000 and 62,000 Euro.

Conclusion: In the Netherlands, the costs of HEMS assistance per QALY remain below the acceptance threshold. HEMS should therefore be considered as cost effective.

MeSH terms

  • Adult
  • Air Ambulances / economics*
  • Air Ambulances / standards
  • Cohort Studies
  • Cost-Benefit Analysis
  • Emergency Medicine / economics*
  • Emergency Medicine / standards
  • Emergency Treatment / economics
  • Emergency Treatment / mortality
  • Emergency Treatment / standards
  • Female
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Quality of Health Care
  • Quality-Adjusted Life Years
  • Wounds and Injuries / economics
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy*