Cost-benefit analysis of community paramedics in an ambulance service.

BACKGROUND: There is an evidence gap on the cost-benefit of community paramedics compared with usual care (emergency ambulance paramedics) for non-emergency patients. METHODS: A prospective, controlled cost-benefit analysis was conducted from both healthcare system and patient out-of-pocket perspectives over a seven-day horizon. Fifty-two presentations were included (30 intervention, 22 control). Costs were measured bottom-up using 67 variables, and consequences were quantified using Willingness-To-Pay. RESULTS: Overall, community paramedics demonstrated an incremental net benefit of $3281 per presentation (95%CI -$41 to $7257) and were cost-beneficial in 97% of bootstrap replications. Healthcare system costs were lower for community paramedics by $3093 per patient (95%CI -$339 to $7030), and patient costs were lower by $45 (95%CI -$46 to $136). Participants were willing to pay $144 (95%CI $92 to $208) for community paramedics instead of usual care, with six reasons provided: avoiding the emergency department, speed, convenience, perceived expertise, interpersonal strengths, and reassurance. Community paramedics needed to see one patient every 2.1 shifts to be cost neutral, and in the previous year provided an estimated benefit of $13.4 million (95%CI -$0.2 to $29.7 million). CONCLUSIONS: Point estimates favour community paramedics across all primary measures and, while limited by sample size, represent a promising economic signal.