Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran V.A. users.
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.


OBJECTIVE
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.
Center for Chronic Disease Outcomes Research, Department of Veterans Affairs Health Care System, Minneapolis, MN 55417, USA. Brent.Taylor2@va.gov
Brent C
BC
Taylor
Emily M
EM
Hagel
Kathleen F
KF
Carlson
David X
DX
Cifu
Andrea
A
Cutting
Douglas E
DE
Bidelspach
Nina A
NA
Sayer
D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D010146:Pain / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics / Q000706:statistics & numerical data*