Comorbid TBI-depression costs in veterans: a chronic effect of neurotrauma consortium (CENC) study

ABSTRACT

Background: The U.S. Veterans Health Administration (VHA) provides depression treatment to veterans with Traumatic Brain Injury (TBI). VHA costs of comorbid TBI-depression were estimated by Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) status over 14 years.

Methods: VHA-USING veterans with TBI DIAGNOSED IN 2000–2010 were followed through FY2014. TBI severity was determined using the Department of Defense criteria. Depression was identified by the Elixhauser algorithm. Generalized linear and seemingly unrelated regression models were used to estimate the impact of depression on annual per veteran and total VHA inpatient, outpatient, and pharmaceutical costs, by OEF/OIF status.

Results: A total of 66.57% of pre-OEF/OIF and 87.46% of OEF/OIF veterans had depression. Depression was estimated to increase annual total ($1,847), outpatient ($1,558), and pharmaceutical ($287) costs for pre-OEF/OIF, and $1,228, $1,685, and $191 for OEF/OIF veterans. However, depression was estimated to lower annual inpatient costs by $648 per OEF/OIF veteran. The annual VHA cost for all veterans with comorbid TBI-depression was estimated at $1,101,329,953.

Conclusions: The estimated annual cost for Veterans with comorbid TBI-depression was more than $1 billion. TBI and depression screening/treatment may result in reduced inpatient VHA costs in OEF/OIF veterans exposed to TBI. VHA policymakers should consider screening for TBI and depression in pre-OEF/OIF veterans.

KEYWORDS:

• Traumatic Brain Injury
• Depression
• Cost
• Veterans
• Military

Conflicts of Interest

This material is based upon work supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium under Award No. W81XWH-13-2-0095. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S. Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.

This work was also supported by the Health Equity and Rural Outreach Innovation Center at the Ralph H. Johnson VA Medical Center, Department of Veterans Affairs Award HX001229. The authors report no conflicts of interest. The views, opinions and or/findings contained in this article are those of the authors and should not be construed as an official Veterans Affairs or Department of Defense position, policy, or decision, unless so designated by other official documentation.

Additional information

Funding

This work was supported by the Department of Veterans Affairs [HX001229];U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium [W81XWH-13-2-0095].

Notes on contributors

C. E. Dismuke-Greer

Dr. Dismuke-Greer is a Research Health Scientist and Health Economist with the U.S. Department of Veterans Affairs.