Prevalence and Costs of Co-occurring Traumatic Brain Injury With and Without Psychiatric Disturbance and Pain Among Afghanistan and Iraq War Veteran VA Users:

Background: Traumatic Brain Injury (TBI) is the "signature injury" in the Afghanistan and Iraq Wars (OEF/OIF). Patients with combat-related TBI also have high rates of psychiatric disturbances and pain. Objectives: 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 utilizing 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 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 four-times higher for TBI-diagnosed veterans as compared to those without TBI ($5,831 versus $1,547). 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 ($7,974). Conclusion: 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.