BACKGROUND: Implementation of telemedicine programs in intensive care units (Tele-ICU) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of Tele-ICU, and collected detailed data on the costs of implementing a Tele-ICU in a network of Veterans Health Administration (VHA) hospitals. METHODS: We conducted a systematic review of studies published between January 1, 1990 and July 1, 2011 reporting costs of Tele-ICU programs. Studies were summarized and key cost data were abstracted. We then obtained the costs of implementing a Tele-ICU program in a network of seven VHA hospitals and report these costs in light of the existing literature. RESULTS: Our systematic review identified eight studies reporting Tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a Tele-ICU program of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after Tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per-ICU bed depending on depreciations methods applied. CONCLUSIONS: The cost of Tele-ICU program implementation is substantial and the impact of these programs on hospital costs or profits are unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of Tele-ICU programs when considering investment in this technology.

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