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RRP 06-198 – HSR&D Study

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RRP 06-198
Predicting Rehabilitation Costs for VA Patients with Traumatic Brain Injury
Henry L. Lew MD PhD
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: November 2006 - May 2007

BACKGROUND/RATIONALE:
Traumatic brain injury (TBI), or post-concussive syndrome, is often referred to as a signature injury of the wars in Iraq and Afghanistan. TBI can cause life-long impairments in physical, cognitive, and social function. Recovery may continue years after initial trauma, carrying societal consequences and medical challenges. Veterans and soldiers with TBI treated at VA facilities sustain injuries either in a non-combat environment (motor vehicle accidents and falls) or in battle (blasts or projectiles). Very little is known about the costs of rehabilitation for combat-related TBI, which may be more complicated to treat than traditional TBI due to polytrauma and acute stress associated with war.

OBJECTIVE(S):
Our goal was to determine rehabilitation care cost differences, if any, between patients with combat-related TBI and those with non-combat-related TBI for up to 24 months.

METHODS:
This retrospective analysis used a convenience sample of 83 veterans with a primary or secondary diagnosis of TBI who were admitted to the James A Haley Polytrauma Rehabilitation Center in Tampa during fiscal years 2005 and 2006. Patient information was extracted from medical charts and administrative datasets. In addition to descriptive statistics, we estimated total costs with an ordinary least squares regression. The outcome of interest (dependent variable) was total cost of inpatient and outpatient care for the two fiscal years in any VA facility, controlling for the effects of combat-related injury, post-traumatic stress disorder (PTSD), length of stay, and the time period for which we had data on each patient.

FINDINGS/RESULTS:
There were 39 patients in the combat-related TBI cohort and 44 in the non-combat-related TBI cohort. Average age (27) was the same for both groups. There was 1 female in the combat-related group compared to 6 in the non-combat-related group, an expected gender distribution. Thirteen of the 18 PTSD diagnoses were in the combat-related TBI group. Average length of stay was 30% higher (14 days more) for those with combat-related TBI. Unadjusted costs per inpatient day (approximately $4,400) were similar for both groups. Average inpatient costs for patients in the combat-related TBI group ($108,300) were much larger than for the non-combat-related group ($65,800), a pattern which held for average outpatient costs ($21,900 for combat-related versus $8,300 for non-combat-related) and average total costs ($130,200 for combat-related versus $74,100 for non-combat-related). Regression results confirmed combat-related TBI was more expensive to treat, on the order of $42,561. Age, gender, and presence of PTSD did not significantly contribute to costs.


IMPACT:
This is one of the first contributions to the cost literature for TBI patients from OEF/OIF. While the cohort was small, this study provides specific cost of care estimates for treatment in VA facilities, and preliminary evidence that caring for combat-related TBI is more expensive than traditional TBI patients.

PUBLICATIONS:

Journal Articles

  1. Bass EB, Siddharthan KS, Lew HL. Health Care Costs for Combat-Related Traumatic Brain Injury in OEF/OIF Veterans. Armed Forces Medicine. 2008 Jan 1;(2008):170-171.
  2. Lew HL, Vanderploeg RD, Moore DF, Schwab K, Friedman L, Yesavage J, Keane TM, Warden DL, Sigford BJ. Overlap of mild TBI and mental health conditions in returning OIF/OEF service members and veterans. Journal of rehabilitation research and development. 2008 Jan 1; 45(3):xi-xvi.


DRA: Military and Environmental Exposures, Health Systems, Acute and Combat-Related Injury
DRE: none
Keywords: Cost, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none