Effectiveness and Cost Analysis of Implementation of Tele-ICU: A Multicenter Administrative Database Study Using...

Background: The telemedicine intensive care unit (tele-ICU) enables remote monitoring and support for intensive care unit (ICU) patients, connecting onsite care teams with remote critical care specialists through audio-video links and electronic data. While it has been shown to improve outcomes and reduce costs in the U.S., evidence on tele-ICU in Japan is limited. The present study aimed to investigate the effectiveness and cost of the implementation of tele-ICU in Japanese hospitals. Methods: This retrospective cohort study used administrative data from two Japanese hospitals where tele-ICU was implemented in April 2018. All adult patients admitted to the ICUs from April 2014 to March 2022 were included. Interrupted time-series analysis was conducted to compare trends in in-hospital mortality, complications, and hospitalization costs before and after tele-ICU implementation, with adjustments for baseline characteristics. Results: A total of 26,684 patients were included. Of these, 10,981 (41%) and 15,703 (59%) were before and after tele-ICU implementation, respectively. After tele-ICU implementation, there were significant downward level changes for in-hospital mortality (-2.62%; 95% confidence intervals -4.08 to -1.16%) and hospitalization costs (-221 thousand yen per patient; -412 to -29.7). A significant downward slope change was observed for complications (-1.82% per year; -2.54 to -1.09%). Subgroup analysis revealed that the mortality reduction was observed mainly in medium-severity, nonsurgery, and general ICU patients. Conclusions: Tele-ICU implementation was associated with lower in-hospital mortality, fewer complications, and lower hospitalization costs, particularly among medium-severity and nonsurgical patients. Further multicenter prospective studies are warranted.