title: Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA; Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA; Stanford Investigators for Surgery, Trauma, and Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA. Electronic address: kit.delgado@uphs.upenn.edu.
authors.forename: M Kit
authors.initials: MK
authors.lastname: Delgado
authors.forename: Kristan L
authors.initials: KL
authors.lastname: Staudenmayer
authors.forename: N Ewen
authors.initials: NE
authors.lastname: Wang
authors.forename: David A
authors.initials: DA
authors.lastname: Spain
authors.forename: Sharada
authors.initials: S
authors.lastname: Weir
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances / Q000191:economics*; D000552:Ambulances / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality / Q000628:therapy*; D055815:Young Adult