What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?
What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?
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DOI：
10.1007/s11999-015-4250-9
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发表时间：
2015-09
影响因子：
4.2
通讯作者：
Clasper JC
中科院分区：
文献类型：
--
作者：
Edwards DS;Phillip RD;Bosanquet N;Bull AM;Clasper JC
个人防护装备、改进的早期医疗护理以及伤员的快速撤离导致更多在阿富汗服役的受伤军人在严重的军事创伤后幸存下来。许多在最初的创伤中幸存下来的人面临着复杂的伤口，如多处截肢。尽管医疗费用可能很高，但以前没有很好地量化。这是为伤者在武装部队服役以外的需要提供预算所必需的。这项研究的目的是(1)量化和描述来自阿富汗的英国服务人员创伤截肢的程度和性质；(2)计算这一队列的预计长期费用。研究方法分为四个阶段：(1)对以往截肢者护理费用的研究进行系统的文献检索；(2)对英国联合剧院创伤和假肢数据库的回顾分析；(3)医疗费用的马尔可夫经济学算法和结果的敏感性分析；(4)我们的队列和确定的文献之间的统计费用比较。从2003年到2014年，265名伤亡人员接受了416次截肢。平均每名伤者失去四肢1.6条。最常见的截肢类型是经股截肢(153例)；其次是单侧胫骨截肢(143例)。使用医疗保健经济学的马尔科夫模型，估计英国阿富汗下肢截肢者队列40年的总成本为2.88亿GB(4.44亿美元)；这个数字估计了创伤护理、康复和假肢的成本。对我们的模型进行的敏感度分析表明，成本可能会发生±66.19%的变化。阿富汗的冲突造成了大量复杂的伤害。我们的发现表明，为退伍军人的医疗保健制定长期预算机制是必要的。这里的估计数应被视为发展持续的复原和恢复资金和提供的挑战的开始。
Personal protection equipment, improved early medical care, and rapid extraction of the casualty have resulted in more injured service members who served in Afghanistan surviving after severe military trauma. Many of those who survive the initial trauma are faced with complex wounds such as multiple amputations. Although costs of care can be high, they have not been well quantified before. This is required to budget for the needs of the injured beyond their service in the armed forces. The purposes of this study were (1) to quantify and describe the extent and nature of traumatic amputations of British service personnel from Afghanistan; and (2) to calculate an estimate of the projected long-term cost of this cohort. A four-stage methodology was used: (1) systematic literature search of previous studies of amputee care cost; (2) retrospective analysis of the UK Joint Theatre Trauma and prosthetic database; (3) Markov economic algorithm for healthcare cost and sensitivity analysis of results; and (4) statistical cost comparison between our cohort and the identified literature. From 2003 to 2014, 265 casualties sustained 416 amputations. The average number of limbs lost per casualty was 1.6. The most common type of amputation was a transfemoral amputation (153 patients); the next most common amputation type was unilateral transtibial (143 patients). Using a Markov model of healthcare economics, it is estimated that the total 40-year cost of the UK Afghanistan lower limb amputee cohort is £288 million (USD 444 million); this figure estimates cost of trauma care, rehabilitation, and prosthetic costs. A sensitivity analysis on our model demonstrated a potential ± 6.19% variation in costs. The conflict in Afghanistan resulted in high numbers of complex injuries. Our findings suggest that a long-term facility to budget for veterans’ health care is necessary. Estimates here should be taken as the start of a challenge to develop sustained rehabilitation and recovery funding and provision.