Abstract
Myocardial infarction (MI) is a life-threatening disease. Accordingly, a time limit of 90 minutes between initial medical contact and percutaneous coronary intervention (PCI) has been established for ST-segment elevation myocardial infarction (STEMI). Thus, many STEMI patients require airlift by helicopter emergency medical services (HEMS) to match the goal of 90 minutes. However, HEMS remains a poorly evaluated aspect of MI-care. The aim of this study was to evaluate the cost-effectiveness of HEMS airlift compared to a ground-based ambulance-transport for patients with MI to a PCI center. A Markov-model was developed based on the distinction between STEMI and non-STEMI to simulate consequences over a 10-year time-horizon. Consequences include recurrent MI, heart failure (HF) due to MI, death due to MI and recurrent MI or other reasons. Health benefits were measured in quality-adjusted life-years (QALYs) and life-years (LYs). Probabilities were derived from the literature. According to data derived from the OEAMTC Air Rescue, 6.9% of all hospital admissions are provided by HEMS. The target value for an appropriate use of HEMS was assumed to be 20%. Direct costs (2020.- €) were derived from published sources from the payer’s perspective. QALYs, LYs and costs were discounted. Monte-Carlo-simulation accounted for uncertainty. A >20% proportion of MI patients who were transported by HEMS to a PCI center is associated with savings over a 10-year time-horizon (2,140.- € to 13,640.- € per patient). Savings are due to reduced follow-up costs for rehabilitation, HF, nursing home and care allowance costs. Patients also achieve a higher life expectancy (0,17 to 0,46 LYs) and quality of life [0,13 to 0,38 QALYs). In the entire cohort of MI patients in 2020 (n=17,305), savings of 37 million euros could be achieved. 1€ spend in HEMS leads to savings of 9.7€ in the health-care and social system.
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