UC Davis investigators have found that telecommunication systems that provide remote monitoring and access to specialty care in intensive care units (ICUs) are cost-effective in most cases and can even be cost-saving in certain circumstances, making this intervention potentially economically favorable compared with other health-care services. Such information is important to hospital administrators who must make decisions on how to efficiently spend available resources to provide lifesaving services and equipment.
The study findings are published in the February issue of the journal Critical Care Medicine, in an article titled, “Economic evaluation of telemedicine for patients in ICUs.”
Telemedicine has become an increasingly viable and attractive option to enable some hospitals to provide critically ill patients with comprehensive monitoring and access to specialists, especially where a large and specialized staff is unavailable onsite. Through telemedicine, remote nursing staff can monitor one or many patients’ clinical indicators such as vital signs, oxygen levels and EKG readings at all times, providing a “second set of eyes” to help determine if a patient’s condition is stable or is deteriorating and needs attention. The system also has the capability to remotely call upon hospital intensivists — internal medicine specialists who are specially trained in hospital care — to advise clinicians on the care of patients.
But telemedicine capabilities in the ICU can appear to be prohibitively expensive to many hospitals, with capital costs of installation estimated to be between $70,000 and $92,000 per ICU bed in the first year and between $34,000 and $53,000 per ICU bed for annual operating costs.
“Our analyses address a critical policy question – whether health outcome improvements from tele-ICU are worth the costs of operation,” said Byung-Kwang Yoo, UC Davis associate professor of public health sciences and lead author of the article. “We found that it is highly likely to be cost-effective compared with other health interventions and services.”
In this study, the investigators conducted mathematical modeling of costs and benefits based on data obtained from published studies of telemedicine integrating a variety of patient populations and clinical outcomes. Health benefits were quantified in units of quality-adjusted life years (QALYs), a measure of improving health outcome taking into account both the length of life and the quality of life. The study authors deemed that the investment for an intensive care unit would be cost-effective if the incremental telemedicine-related costs to extend one year of life of a single patient were less than $100,000 per QALY, a typical threshold applied in similar modeling studies to determine cost-effectiveness of a medical intervention or therapy. By comparison, dialysis for patients with kidney failure has been estimated to cost approximately $129,000 per QALY. The investigators also found that cost savings to the hospital could be achieved in some circumstances if the positive impact of tele-ICU on ICU care cost was large and the costs of telemedicine per patient were low.
“The benefit of tele-ICU is probably highest in ICUs with fewer resources and the least access to critical care health providers,” said James Marcin, division chief of pediatric critical care medicine at UC Davis and senior author of the article. “Hospitals that one might think can least afford to take on telehealth would likely derive the biggest impact from such a program,” added Marcin, who also directs the UC Davis Pediatric Telemedicine Program.
Yoo expects that in the future, increasing competition among companies offering telemedicine services will drive the costs down, making the service even more cost-effective or cost-saving than what they found in their models.
“Although not explicitly announced, insurers appear to be willing to cover new services that have solid and cost-effective evidence,” said Yoo. “This kind of study helps provide policymakers with evidence-based choices for determining the best way to spend limited dollars.”
Other UC Davis study authors include Minchul Kim of the Department of Public Health Sciences and Joy Melnikow, professor and chair of the Department of Family and Community Medicine, as well as Tomoko Sasaki, an independent consultant.