The costs of critical care telemedicine programs: a systematic review and analysis.
BACKGROUND
Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals.


METHODS
We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature.


RESULTS
Our systematic review identified eight studies reporting tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied.


CONCLUSIONS
The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology.
Division of Pulmonary, Critical Care, and Occupational Health, Iowa City Veterans Affairs Medical Center, Iowa City, IA; Department of Internal Medicine, University of Iowa Carver College of Medicine; the Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA. Electronic address: gaurav-kumar@uiowa.edu.
Gaurav
G
Kumar
Division of Pulmonary, Critical Care, and Occupational Health, Iowa City Veterans Affairs Medical Center, Iowa City, IA.
Derik M
DM
Falk
Minneapolis Veterans Affairs Medical Center, Minneapolis, MN.
Robert S
RS
Bonello
Program on Critical Care Health Policy and Management, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
Jeremy M
JM
Kahn
Division of General Internal Medicine, Iowa City Veterans Affairs Medical Center, Iowa City, IA; Department of Internal Medicine, University of Iowa Carver College of Medicine; the Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA.
Eli
E
Perencevich
Division of General Internal Medicine, Iowa City Veterans Affairs Medical Center, Iowa City, IA; Department of Internal Medicine, University of Iowa Carver College of Medicine; the Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, IA.
Peter
P
Cram
D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics*; D017721:Hospital Costs; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D017216:Telemedicine / Q000191:economics*