title: The effect of pre-existing health conditions on the cost of recovery from road traffic injury: insights from data linkage of medicare and compensable injury claims in Victoria, Australia.
abstract: Comorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the immediate post-accident care period. The aim of this study was to investigate the role of pre-existing health conditions in the cost of recovery from road traffic injury using health service use records for 1 year before and after the injury.
  
  
  
  Individuals who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) linkage were included (n = 738) in the analysis. PBS and MBS records dating from 12 months prior to injury were provided by the Department of Human Services (Canberra, Australia). Pre-injury use of health service items and pharmaceuticals were considered to indicate pre-existing health condition. Bayesian Model Averaging techniques were used to identify the items that were most strongly correlated with recovery cost. Multivariate regression models were used to determine the impact of these items on the cost of injury recovery in terms of compensated ambulance, hospital, medical, and overall claim cost.
  
  
  
  Out of the 738 study participants, 688 used at least one medical item (total of 15,625 items) and 427 used at least one pharmaceutical item (total of 9846). The total health service cost of recovery was $10,115,714. The results show that while pre-existing conditions did not have any significant impact on the total cost of recovery, categorical costs were affected: e.g. on average, for every anaesthetic in the year before the accident, hospital cost of recovery increased by 24 % [95 % CI: 13, 36 %] and for each pathological test related to established diabetes, hospital cost increased by $10,407 [5466.78, 15346.28]. For medical costs, each anaesthetic led to $258 higher cost [174.16, 341.16] and every prescription of drugs used in diabetes increased the cost by 8 % [5, 11 %].
  
  
  
  Services related to pre-existing conditions, mainly chronic and surgery-related, are likely to increase certain components of cost of recovery after road traffic trauma but pre-existing physical health has little impact on the overall recovery costs.
authors.affiliation: Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia. behrooz.hassani.mahmooei@monash.edu.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Hassani-Mahmooei
authors.affiliation: Monash Injury Research Institute, Monash University, Melbourne, Australia.
authors.forename: Janneke
authors.initials: J
authors.lastname: Berecki-Gisolf
authors.affiliation: Department of Economics, Yonsei University, Seoul, South Korea.|Department of Economics, Monash University, Melbourne, Australia.
authors.forename: Youjin
authors.initials: Y
authors.lastname: Hahn
authors.affiliation: Harvard Injury Control Research Centre, Harvard School of Population Health, Boston, USA.
authors.forename: Roderick J
authors.initials: RJ
authors.lastname: McClure
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001499:Bayes Theorem; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007902:Length of Stay; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D064266:Preexisting Condition Coverage / Q000191:economics*; D020127:Recovery of Function; D014739:Victoria; D055815:Young Adult
keywords: Australia; Health service use; Injury; Pre-existing conditions; Recovery; Traffic accident