Prevalence and Costs of Co-occurring Traumatic Brain Injury With and Without Psychiatric Disturbance and Pain Among Afghanistan and Iraq War Veteran VA Users
Prevalence and Costs of Co-occurring Traumatic Brain Injury With and Without Psychiatric Disturbance and Pain Among Afghanistan and Iraq War Veteran VA Users
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DOI：
10.1097/mlr.0b013e318245a558
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发表时间：
2012-04-01
期刊：
影响因子：
3
通讯作者：
Sayer, Nina A.
中科院分区：
文献类型：
--
作者：
Taylor, Brent C.;Hagel, Emily M.;Sayer, Nina A.
背景：创伤性脑损伤（TBI）是阿富汗和伊拉克战争[阿富汗持久自由行动(OEF)/伊拉克自由行动（OIF）]中的“标志性损伤”。与战斗相关的创伤性脑损伤患者也有很高的精神障碍和疼痛率。目的：确定创伤性脑损伤单独和创伤性脑损伤合并其他疾病的患病率以及这些诊断的退伍军人的平均医疗费用。方法：观察性研究使用来自退伍军人健康管理局（VHA）数据集的全国住院、门诊和药房数据。费用是根据与VHA系统内的护理有关的利用来估计的。参与者均为2009年OEF/OIF VHA用户。结果：在2009年使用VHA服务的327,388名OEF/OIF退伍军人中，6.7%被诊断为TBI。在被诊断为TBI的患者中，89%被诊断为精神疾病（最常见的是创伤后应激障碍（PTSD），占73%），70%被诊断为头部、背部或颈部疼痛。在有创伤性脑损伤和没有创伤性脑损伤的患者中，合并PTSD和疼痛的比例分别为54%和11%。诊断为TBI的退伍军人的平均年费用几乎是没有TBI的退伍军人的4倍（5831美元对1547美元）。在创伤性脑损伤组中，费用随着诊断复杂性的增加而增加，例如那些患有创伤性脑损伤、疼痛和创伤后应激障碍的患者显示出最高的平均每位患者费用（7974美元）。结论：绝大多数诊断为TBI的VHA患者也有诊断为精神障碍，超过一半的患者同时患有创伤后应激障碍和疼痛。患有这些合并症的患者会产生大量的医疗费用，并代表了未来旨在提高医疗效率的研究的目标人群。
Background: Traumatic brain injury (TBI) is the "signature injury" in the Afghanistan and Iraq wars [Operation Enduring Freedom in Afghanistan (OEF)/Operation Iraqi Freedom (OIF)]. Patients with combat-related TBI also have high rates of psychiatric disturbances and pain.Objectives: To 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 using 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 posttraumatic stress disorder (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 4-times higher for TBI-diagnosed veterans as compared with those without TBI ($5831 vs. $1547). 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 ($7974).Conclusions: 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.