Citation

Taylor BC, Hagel EM, Carlson KF, Cifu DX, Cutting A, Bidelspach DE, Sayer NA. Med. Care. 2012; 50(4): 342-346.

Affiliation

*Center for Chronic Disease Outcomes Research, Department of Veterans Affairs Health Care System †Department of Medicine ‡Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN §Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, VA Medical Center ∥Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR ¶Physical Medicine and Rehabilitation Services, Veterans Health Administration, Physical Medicine and Rehabilitation Service, Hunter Holmes McGuire VA Medical Center #Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA **Physical Medicine and Rehabilitation Services, Veterans Health Administration, VA Medical Center, Lebanon, PA ††Department of Psychiatry, University of Minnesota, Minneapolis, MN.

Copyright

(Copyright © 2012, American Public Health Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/MLR.0b013e318245a558

PMID

22228249

Abstract

BACKGROUND:: Traumatic brain injury (TBI) is the "signature injury" in the Afghanistan and Iraq wars [Operation Enduring Freedom in Afghanistan (OEF)/Operation Iraqi Freedom (OIF)]. Patients with combat-related TBI also have high rates of psychiatric disturbances and pain. OBJECTIVES:: To determine the prevalence of TBI alone and TBI with other conditions and the average cost of medical care for veterans with these diagnoses. METHODS:: Observational study using national inpatient, outpatient, and pharmacy data from Veterans Health Administration (VHA) datasets. Costs are estimated from utilization related to care within the VHA system. Participants were all OEF/OIF VHA users in 2009. RESULTS:: Among 327,388 OEF/OIF veterans using VHA services in 2009, 6.7% were diagnosed with TBI. Among those with TBI diagnoses, 89% were diagnosed with a psychiatric diagnosis [the most frequent being posttraumatic stress disorder (PTSD) at 73%], and 70% had a diagnosis of head, back, or neck pain. The rate of comorbid PTSD and pain among those with and without TBI was 54% and 11%, respectively. The median annual cost per patient was nearly 4-times higher for TBI-diagnosed veterans as compared with those without TBI ($5831 vs. $1547). Within the TBI group, cost increased as diagnostic complexity increased, such that those with TBI, pain, and PTSD demonstrated the highest median cost per patient ($7974). CONCLUSIONS:: The vast majority of VHA patients diagnosed with TBI also have a diagnosed mental disorder and more than half have both PTSD and pain. Patients with these comorbidities incur substantial medical costs and represent a target population for future research aimed at improving health care efficiency.

Language: en