title: Resource utilization and costs of stroke unit care in Germany.
abstract: OBJECTIVE
  Stroke imposes a considerable economic burden on the individual and society. Recently, the concept of an integrated stroke unit has been established in several countries to improve the outcome of patients. This study evaluates the costs of acute care of the different cerebrovascular insults in a stroke unit.
  
  
  METHODS
  The study population included 340 patients who were consecutively admitted to the Department of Neurology, Philipps University Marburg, with the diagnosis of stroke or transient ischemic attack (TIA) between January 1 and June 30, 2000. Clinical status and course were evaluated by using the Barthel index and the modified Rankin scale. Employing a "bottom-up" approach, we calculated the costs from the perspective of the hospital and the third-party payer using data from provider departments and other published sources.
  
  
  RESULTS
  Inpatient costs were 3020 euros (3290 US dollars) for TIA, 3480 euros (3790 US dollars) for ischemic stroke (IS), and 5080 euros (5540 US dollars) for intracerebral hemorrhage (ICH) and differed significantly among these subgroups (P < .05). Patient subgroups ranked in the same order for average length of stay at 9.4 days for TIA, 10.2 days for IS, and 11.9 days for ICH (P > .05). Approximately 30% of the hospital costs are due to physician charges and care. Imaging amounted to 10% and lab investigations to 14% of total costs, independent of the diagnosis. Postacute treatment, including inpatient rehabilitation, cost 9880 euros per patient. Across all diagnostic groups, a mean clinical improvement was observed at time of discharge.
  
  
  CONCLUSIONS
  Care of patients with cerebrovascular events in a stroke unit causes a high demand of resources and has a considerable impact on health-care expenditure. Therefore, investigations comparing the stroke unit concept with other strategies in stroke care are necessary to evaluate the stroke unit concept for a rational use of available resources in patients with cerebrovascular events.
authors.affiliation: Department of Neurology and Institute of Medical Biometry and Epidemiology, Philipps-University, Marburg, Marburg, Germany. richard.dodel@ukb.uni-bonn.de
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dodel
authors.forename: Caroline
authors.initials: C
authors.lastname: Haacke
authors.forename: Karin
authors.initials: K
authors.lastname: Zamzow
authors.forename: Sven
authors.initials: S
authors.lastname: Paweilik
authors.forename: Annika
authors.initials: A
authors.lastname: Spottke
authors.forename: Mira
authors.initials: M
authors.lastname: Rethfeldt
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.forename: Oliver
authors.initials: O
authors.lastname: Schöffski
authors.forename: Tobias
authors.initials: T
authors.lastname: Back
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000191:economics / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000191:economics / Q000628:therapy; D017281:Cost of Illness; D005260:Female; D005858:Germany; D006295:Health Resources; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D014600:Utilization Review / Q000191:economics*