Pharyngeal electrical stimulation for postextubation dysphagia after stroke: a randomized trial on hospitalization costs from a health insurance perspective

TL;DR

This study explores whether pharyngeal electrical stimulation reduces hospital costs for stroke patients with swallowing difficulties, but finds no significant difference in average costs.

Contribution

The study provides early evidence on the potential cost impact of pharyngeal electrical stimulation for post-stroke dysphagia from a health insurance perspective.

Findings

Mean hospital costs were lower in the PES group but not statistically significant.

Three high-cost outliers occurred only in the sham group.

Results suggest a need for larger studies to confirm cost-effectiveness.

Abstract

Dysphagia is a frequent and serious complication after stroke, associated with pneumonia, malnutrition, prolonged intensive care unit stay, and higher healthcare costs. Pharyngeal electrical stimulation (PES) is a novel therapy that may support recovery from postextubation dysphagia. This study assessed the cost-effectiveness of PES in stroke patients from a health insurance perspective. We performed a secondary analysis of a randomized controlled trial including 60 stroke patients with postextubation dysphagia, randomized to PES (n = 30) or sham stimulation (n = 30). Sham treatment involved identical device placement without stimulation. Acute hospital costs were estimated per patient using the 2025 German Diagnosis-Related Groups (DRG) reimbursement system. Mean costs were compared between groups with a one-sided t-test, and distributions were explored with boxplots. Mean DRG costs per patient were €22,392.89 (SD = €14,980.84) in the sham group and €18,127.20 (SD = €7,828.65) in the PES group. The difference was not statistically significant (p = 0.087). However, three outliers with costs >€50,593 occurred in the sham group, compared with none in the PES group (maximum €35,257.49). Although the difference in mean hospitalization costs between groups was not statistically significant, extreme high-cost outliers occurred only in the sham group in this pilot sample. This observation is exploratory and hypothesis-generating and requires confirmation in larger, adequately powered health-economic studies before firm conclusions regarding cost-effectiveness can be drawn.

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