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

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.