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.
Bibliographical noteFunding Information:
Funding/Support: Supported by the Veterans Affairs Health Services Research & Development [Grant IIR 09-099] (Dr Perencevich); in-kind research support in the form of data from the Cerner Corp (Kansas City, MO) and the National Institutes of Health career development award [K23HL082650] (Dr Kahn); a K23 career development award [RR01997201] from the National Center for Research Resources at the National Institutes of Health and the Robert Wood Johnson Physician Faculty Scholars Program (Dr Cram); and the Department of Veterans Affairs (Drs Perencevich and Cram). This work is also funded by a VA Merit Award [I01 HX000261] .
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Kahn receives grant funding from the US National Institutes of Health and has served as a paid consultant to the US Department of Veterans Affairs on issues related to ICU telemedicine. Drs Kumar, Falk, Bonello, Perencevich, and Cram have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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