Survival and cost-effectiveness of helicopter versus ground emergency medical services: a systematic review and meta-analysis with meta-regression and trial sequential analysis.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 2025-10-03 · Meta-analysis
Abstract
OBJECTIVE: To synthesise the available literature comparing outcomes of ground emergency medical services (GEMS) and helicopter emergency medical services (HEMS). METHODS: We conducted a systematic review and meta-analysis, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from 1995 to 2024. Studies comparing HEMS with GEMS in emergency conditions were eligible. RESULTS: The search retrieved 1,595 records; 181 studies were assessed in full text, and 77 were included, accounting for a pooled population of 2,618,483 patients. The relative risk (RR) of mortality in HEMS compared with GEMS was 1.13 (95% CI 0.96-1.34). The RR of disability was 1.24 (95% CI 0.99-1.55). The total incremental net benefit was €980,000 per QALY per patient, based on cost-effectiveness studies and a willingness-to-pay threshold of €35 million per QALY per patient. CONCLUSION: Very low-quality evidence, due to high heterogeneity, potential confounding from registry-based enrolment, and possible multiple imputation bias, suggested that HEMS did not improve survival compared with GEMS. High-quality studies are needed to further investigate this question. CLINICAL TRIAL REGISTRATION: PROSPERO: International prospective register of systematic reviews, 2024, CRD42024628317.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Helicopter & air ambulance · Cost & cost-effectiveness · Interfacility & critical care transport · Mortality & survival · Quality of life & function
Related articles
- Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States. (Ann Emerg Med, 2013)
- The cost-effectiveness of physician staffed Helicopter Emergency Medical Service (HEMS) transport to a major trauma centre in NSW, Australia. (Injury, 2012)
- Cost-effectiveness and quality-of-life analysis of physician-staffed helicopter emergency medical services. (Br J Surg, 2009)
- A cost and outcomes comparison of a novel integrated pediatric air and ground transportation system. (J Am Coll Surg, 2002)
- HEMS vs. EMS transfer for acute aortic dissection type A. (Air Med J, 2009)
- A scenario based approach to optimizing cost-effectiveness of physician-staffed Helicopter Emergency Medical Services compared to ground-based Emergency Medical Services in Finland. (Scand J Trauma Resusc Emerg Med, 2024)