• Byung-Kwang Yoo, Minchul Kim, Tomoko Sasaki, Joy Melnikow, and James P Marcin.
• 1Department of Public Health Sciences, University of California, Davis, Davis, CA. 2Independent Consultant, Rochester, NY. 3Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA. 4Department of Pediatrics, Center for Healthcare Policy and Research, Center for Health and Technology, University of California, Davis, Sacramento, CA.
• Crit. Care Med. 2016 Feb 1; 44 (2): 265-74.

ObjectiveDespite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses.DesignSimulation analyses performed by standard decision models.SettingHypothetical ICU defined by the U.S. literature.PatientsHypothetical adult patients in ICU defined by the U.S. literature.InterventionsThe intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge.Measurements And Main ResultsThe base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on break-even analyses.ConclusionsOur analyses suggest that telemedicine in the ICU is cost-effective in most cases and cost saving in some cases. The thresholds of cost and effectiveness, estimated by break-even analyses, help hospitals determine the impact of telemedicine in the ICU and potential cost saving.

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