Economics of Traumatic Brain Injury (TBI) Biomarkers

Abstract

<h3>Research Objectives</h3> To investigate the annual utilization, unit and per veteran Veterans Health Administration (VHA) costs of CT and MRI in U.S. veterans with Traumatic Brain Injury (TBI), by TBI severity. To also examine the marginal impact of CT and MRI use on total, inpatient, outpatient and pharmacy (VHA) cost of veterans diagnosed with TBI. <h3>Design</h3> All VHA using veterans diagnosed with TBI between 2000-2010 and followed until 2014. <h3>Setting</h3> VHA Medical Centers and Community Based Outpatient Clinics. <h3>Participants</h3> 79,276 veterans identified with a TBI diagnosis. <h3>Interventions</h3> Logit models were used to predict the utilization of any CT or MRI, Poisson models for number of CT and MRI and generalized linear as well as seemingly unrelated regression models for annual VA inpatient, outpatient and pharmacy costs in 2018 dollars. All models were adjusted for TBI severity as well as comorbidities. <h3>Main Outcome Measures</h3> VHA CT and MRI utilization and VHA inpatient, outpatient and pharmacy costs. <h3>Results</h3> 84.78% of all veterans with TBI had CT and 61.29% had MRI. The mean ($468), median ($422) cost per unit for CT was lower than MRI mean ($732), median ($639). The odds (1.43; 95% CI 1.37:1.49) of CT increased with higher TBI severity and declined for MRI (0.68; 95% CI 0.66:0.71). The marginal effect of CT use was $1,775 (95% CI $1,514:$2,035) on annual total, $1,646 (95% CI $1,529:$1,763) on outpatient, and $373 (95% CI $315:$431) on pharmacy cost per veteran. The marginal effect of any MRI use was $851 (95% CI $582:$1,120) on total, -$1,522 (95% CI -$1,742:-$1,302) on inpatient cost, $1,983 (95% CI $1,899:$2,067) on outpatient, and $389 (95% CI $348:$431) on pharmacy cost. <h3>Conclusions</h3> MRI use was associated with a significant reduction in annual inpatient costs per veteran, even though its cost per unit was higher than CT. <h3>Author(s) Disclosures</h3> 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 Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award No. l01 HX003155.