Military, Demographic, and Clinical Factors Associated with DOD Costs Post-traumatic Brain Injury (TBI)

Research Objectives: To examine annual total, inpatient and outpatient Military Treatment Facility (MTF) and TRICARE/other payer costs after Traumatic Brain Injury (TBI) for Service Members (SMs) treated in Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs).

Design: VA TBIMS and DOD (DaVINCI) administrative datasets merged to model the influence of military, demographic, injury and clinical factors with DOD costs.

Setting: Military Treatment Facilities and community care.

Participants: National cohort of SMVs admitted for inpatient TBI rehabilitation at any of the 5 VA PRCs.

Interventions: N/A

Main Outcome Measures: Total cost of inpatient and outpatient care at MTF and community care. Costs are reported in 2023 dollars.

Results: The analyses included a total cohort of 1101 Service Members. Mean age was 31, with 9.8 years of service and time in MHS was 7.18 years. Mean annualized total MHS cost of care was $161,470. Mean inpatient cost was $22,126 in MTFs and $112,219 in TRICARE. Mean outpatient cost was $17,984 in MTFs and $9,141 in TRICARE. In the fully adjusted annualized cost model, each additional year of age was associated with $8,276 (95% CI 4068, 12483) higher annual costs; LOS was associated with $1,024 (95% CI 8, 2039) higher costs, and DRS was associated with $10,858 (95% CI 4273, 17,442) higher costs.

Conclusions: Service Members injured with TBI who received inpatient rehabilitation in PRCs received most of their inpatient care in the community (TRICARE), while most of their outpatient care was received in MTFs. The factors having the largest impact on annual total cost was DRS score, followed by age and then acute care LOS prior to inpatient rehabilitation. This is different from findings for VA where PTA had a major impact on first year hospital costs.

Author(s) Disclosures: Financial Disclosures: None. The views expressed in this presentation are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. This work was prepared under Contract HT0014-22-C-0016 with DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. Poster presented at ACRM, November 2024. For more information, please contact dha.TBICOEinfo@health.mil. UNCLASSIFIED. This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.