title: Benchmark data on the utilization and acquisition costs of central nervous system and muscular skeletal drugs among veterans with combat-related injuries.
abstract: BACKGROUND
  Little is known about the utilization and costs of central nervous system (CNS) and musculoskeletal medications in veterans with blast injuries.
  
  
  METHODS
  Two years of national medication records of Operations Enduring Freedom and Iraqi Freedom veterans with blast injuries were extracted from the Veterans Health Administration Decision Support System and analyzed with descriptive statistics.
  
  
  RESULTS
  Over the 2-year period, there was a total of 23,795 pharmacy claims (various drug classes) for 60 patients with blast injuries with a 2-year drug acquisition cost of $111,535 (mean per patient = $1,858; median per patient = $960). There were 6,471 CNS pharmacy claims or 4.5 CNS pharmacy claims per patient per month. Over four (81.6%) of five veterans were prescribed opioid analgesics; 75.0% (45 of 60) received antidepressants; 68.3% (41 of 60) received anticonvulsants; 40% (24 of 60) received antipsychotics; and 41.6% (25 of 60) received sedative hypnotics. The drug acquisition cost of all CNS medications was $46,384 ($7.17 per claim) and accounted for over 41% of total medication spending. For musculoskeletal medications, there were 1,253 pharmacy claims for 32 patients or 53% of the cohort costing $5,015 ($4.00 per claim), which accounted for 4.5% ($5,015 of $111,535) of total medication spending.
  
  
  CONCLUSIONS
  The analysis suggests that these combat-wounded veterans were discharged on CNS medications with potential side effects, although the magnitude of these side effects, if any, remains unknown.
authors.affiliation: James A. Haley VAMC, VISN-8 Patient Safety Center of Inquiry, 13000 Bruce B. Downs Boulevard (118M), Tampa, FL 33612, USA. Dustin.French@VA.gov
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.forename: Kris
authors.initials: K
authors.lastname: Siddharthan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bass
authors.forename: Robert R
authors.initials: RR
authors.lastname: Campbell
mesh_terms: D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use; D019985:Benchmarking / Q000706:statistics & numerical data*; D001753:Blast Injuries / Q000188:drug therapy*; D002490:Central Nervous System / Q000293:injuries*; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics*; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D018482:Muscle, Skeletal / Q000293:injuries*; D012189:Retrospective Studies; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D014857:Warfare
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009125:Muscle Relaxants, Central