The Cost and Effectiveness of the London Helicopter Emergency Medical Service

Abstract

Objectives: To assess the incremental consequences of the London Helicopter Emergency Medical Service (HEMS) for the outcomes of survivors in terms of disability and health status, and cost. Methods: Prospective comparison of outcomes in cohorts of seriously injured patients attended either by the HEMS or by paramedically crewed land ambulances. In survivors, disability was assessed using an 11-point disability scale, and general health status was measured by the six dimensions of the 100-point Nottingham Health Profile (NHP) assessed 6 months after the injury. Costs were estimated for the HEMS and associated facilities at the Royal London Hospital, and the extra admissions attributable to the HEMS. Results: There was no evidence of reduced disability in HEMS survivors (estimate: +0.8 disability grades worse; 95% CI: 0, 1.6), and no evidence of improvement in the six NHP dimension scores or in the mean number of problems with seven aspects of daily living (estimated difference: +0.5; 95% CI: −0.2, 1.2). The incremental costs of HEMS were estimated to be £2.0 million a year. Conclusion: As there is no evidence of any improvement in outcomes overall for the extra cost, the HEMS has not been found to be a cost-effective service.