Costs and cost-effectiveness of a telemedicine intensive care unit program in 6 intensive care units in a large health care system

Purpose: The purpose of this study is to estimate the costs and cost-effectiveness of a telemedicine intensive care unit (ICU) (tele-ICU) program. Materials and Methods: We used an observational study with ICU patients cared for during the pretele-ICU period and ICU patients cared for during the post-tele-ICU period in 6 ICUs at 5 hospitals that are part of a large nonprofit health care system in the Gulf Coast region. We obtained data on a sample of 4142 ICU patients: 2034 in the pre-tele-ICU period and 2108 in the post-tele-ICU period. Economic outcomes were hospital costs, ICU costs and floor costs, measured for average daily costs, costs per case, and costs per patient. Results: After the implementation of the tele-ICU, the hospital daily cost increased from $4302 to $5340 (24%); the hospital cost per case, from $21 967 to $31 318 (43%); and the cost per patient, from $20 231 to $25 846 (28%). Although the tele-ICU intervention was not cost-effective in patients with Simplified Acute Physiology Score II 50 or less, it was cost-effective in the sickest patients with Simplified Acute Physiology Score II more than 50 (17% of patients) because it decreased hospital mortality without increasing costs significantly. Conclusions: Hospital administrators may conclude that a tele-ICU program aimed at the sickest patients is cost-effective. (C) 2011 Elsevier Inc. All rights reserved.