title: [Cost analysis of telemedical treatment of stroke].
abstract: BACKGROUND
  Telemedicine-enabled stroke networks increase the probability of a good clinical outcome. There is a shortage of evidence about the effects of this new approach on costs for inpatient care and nursing care.
  
  
  METHODS
  We analysed health insurance and nursing care fund data of a statutory health insurance company (AOK Bayern). Data from stroke patients initially treated in a TeleStroke network (TEMPiS - telemedical project for integrative stroke care) between community hospitals and academic stroke centres were compared to data of matched hospitals without specialised stroke care and telemedical support. Costs for nursing care were obtained over a 30-month period after the initial stroke. To rule out pre-existing differences between network and control hospitals, costs of stroke care were also analysed during a time period before network implementation.
  
  
  RESULTS
  1 277 patients (767 in intervention, 510 in control hospitals) were analysed in the post-implementation period. An increased proportion of patients treated in intervention hospitals had a favourable outcome concerning the level of required nursing care. Patients in intervention hospitals had higher costs for acute inpatient care (5 309 € vs. 4 901 €, p=0.04), but lower nursing care fund costs (3 946 € vs. 5 132 €; p=0.04). There was no difference in relation to absolute total costs obtained in the post-implementation period. However, nursing care costs per survived year were significantly lower in intervention hospitals (1 953 € vs. 2 635 €; p=0.005). No significant differences were found in the pre-implementation period.
  
  
  CONCLUSIONS
  Considering both health insurance and nursing care fund costs, the incremental costs for TeleStroke network care in hospitals are compensated by savings in outpatient care.
authors.affiliation: Bundesärztekammer, Dezernat Telematik, Berlin. johannes.schenkel@baek.de
authors.forename: J
authors.initials: J
authors.lastname: Schenkel
authors.forename: P
authors.initials: P
authors.lastname: Reitmeir
authors.forename: S
authors.initials: S
authors.lastname: Von Reden
authors.forename: R
authors.initials: R
authors.lastname: Holle
authors.forename: S
authors.initials: S
authors.lastname: Boy
authors.forename: R
authors.initials: R
authors.lastname: Haberl
authors.forename: H
authors.initials: H
authors.lastname: Audebert
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004471:Economics, Nursing / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018803:Models, Economic; D009732:Nursing Care / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000451:nursing*; D017216:Telemedicine / Q000191:economics* / Q000706:statistics & numerical data