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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)

Objectives:
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.

Methods:
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.

Results:
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).

Implications:
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.

Impacts:
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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