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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1077 — Prevalence and Costs of Co-Occurring TBI, Psychiatric Disturbance, and Pain among OEF/OIF VA Users

Taylor BC (COE - Minneapolis), Hagel EM (COE - Minneapolis), Cifu DX (VA National PM&R Program Office), Bidelspach DE (VA National PM&R Program Office), Sayer NA (COE - Minneapolis)

a) Describe the prevalence of PTSD and pain disorders among OEF/OIF VA users with and without TBI. b) Compare the VA costs for OEF/OIF patients who have co-occurring TBI, PTSD, and pain to less clinically complex patients.

Observational study using national inpatient, outpatient, and ADUSH enrollment datasets, including costs estimated from VHA Allocation Resource Center (ARC) costs. Costs are estimated from utilization related to inpatient care, long-term care, and outpatient care at or paid for by the VA. Participants were all OEF/OIF VA users in FY2009. Analyses included descriptive statistics and multivariable-adjusted prevalence risk ratios from log binomial regression models.

Among the 327,388 OEF/OIF veterans who used VA in FY2009, 6.7% received a TBI diagnosis, 42% received a psychiatric diagnosis, with PTSD being the most common (28%), and 33% received a pain diagnosis during that year. Among those with a TBI diagnosis, 73% had a diagnosis of PTSD and 70% had a diagnosis of head, back, or neck pain. The rate of combined PTSD and pain diagnoses in OEF/OIF VA users with TBI was 54% compared with 11% among those without TBI. The co-occurring diagnoses difference remained largely unchanged in multivariable models adjusted for age, gender, race/ethnicity, and whether or not the veteran was a new user of VA services (RR = 4.4, 95% CI 4.3, 4.5). Median annual cost per patient was four times higher for TBI-diagnosed OEF/OIF veterans than those without TBI ($6,455 versus $,1549). Within the TBI group, an increase in costs was noted as diagnostic complexity increased, such that those with TBI and pain ($4,350) or TBI and PTSD ($5,534) incurred more health-related costs than those with TBI alone ($2,660), and those with TBI, pain and PTSD demonstrated the highest median cost per patient ($8,716).

Findings confirm that PTSD and pain are common in OEF/OIF veterans with diagnosed TBI and these findings demonstrate the relatively high costs of providing services to patients with this triad of clinical problems.

Findings have implications for allocation of resources and planning of service delivery for clinically complex OEF/OIF patients using VA services, and can serve as a platform for future research.

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