Cost-effectiveness of eICU in reducing morbidity and mortality in ICUs

Introduction: Patients in adult intensive care units (ICUs) require multidisciplinary care that frequently results in substantial morbidity, mortality, and costs. Telemedicine has been used to provide remote intensivist monitoring for ICUs. Remote ICU monitoring (e-ICU) was found to reduce mortality and morbidity as much as onsite intensivist staffing, which is associated with a 29% reduction in hospital mortality and a 49% reduction in ICU mortality. In this study we measure the cost-effectiveness of e-ICU in 8 hospitals in the Houston metropolitan area. Methods: We assess the cost-effectiveness of e-ICU by comparing the costs and clinical outcomes in the period after the full implementation of the eICU with the costs and clinical outcomes in the baseline period before the introduction of the eICU. The cost-effectiveness analysis in this study adopts a hospital perspective because the decision to implement an eICU is made at the hospital or health system level. Clinical outcomes are measured by ICU and hospital LOS and ICU and hospital mortality, obtained from chart reviews, and costs are measured by hospital costs and the cost of operating the eICU. Hospital costs are computed using average daily ICU costs and floor costs for patients in each ICU during the two study periods using individual patient data. Two methodologies for assessing costs are used. First, costs are obtained by multiplying charges by Medicare ratios of cost to charge. The second approach to assessing hospital costs is based on costs as computed by the hospitals' cost-accounting system. Cost accounting costs are built up from information on resource-use and are a more accurate representation of economic costs. Additionally, we perform a reimbursement analysis to assess the eICU's impact on hospital revenues by comparing per-case revenue and monthly revenue in the baseline period and the eICU period. Results: Based on previous studies, we expect to find that the e-ICU reduces hospital costs and improves mortality and morbidity outcomes. Complete results will be available at the time of presentation. Conclusions: Introducing e-ICU may be a very cost-effective intervention for reducing costs of ICU, which consume 20-34% of all acute care resources and total 1% of the U.S. gross domestic product.