Impact of Post-Traumatic Amnesia on Traumatic Brain Injury (TBI) First Year Hospitalization Costs in TBIMS

Abstract

Research Objectives: Examine the association between Posttraumatic Amnesia (PTA) duration and first year hospitalization costs in military servicemembers and veterans (SM/Vs) with TBI. <h3>Design</h3> Multivariable models of merged datasets from the Veterans Affairs TBI Model Systems (TBIMS) national database containing TBI clinical characterization including PTA and Veterans Health Administration (VHA) administrative cost data. <h3>Setting</h3> Five VA Polytrauma Rehabilitation Centers. <h3>Participants</h3> TBIMS participants (N=910 veterans and 77 active-duty service members) who received inpatient rehabilitation at one of the five Polytrauma Rehabilitation Centers between 2010-2020 and were admitted and discharged from rehabilitation within 1 year of their TBI. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> acute care, rehabilitation, intensive care unit and surgery costs in VA hospitals. <h3>Results</h3> The total unadjusted mean first year cost was $149,943 per patient for those with PTA< 24 hours and $351,157 for those with PTA≥24 hours. Significant covariates in adjusted modeling included: age, time from TBI to rehabilitation, DRS on admission, drug abuse comorbidity, penetrating mechanism of injury, and PTA duration. Penetrating mechanism of injury had the highest impact with $80,886 increase in rehabilitation cost, relative to vehicular injury. For each additional day of PTA, costs were increased for rehabilitation ($1,324), surgery ($38) and ICU ($78) care. <h3>Conclusions</h3> This study, the first to evaluate factors related to cost of VHA hospitalization in the first year following TBI for SM/Vs, shows the impacts of severity measured by PTA duration and penetrating mechanism. We also show average total costs in the first year were far higher than the Veterans Equitable Resource Allocation (VERA) highest allocation to VA facilities for a Veteran treated in a PRC of $77,964 for FY 2021. <h3>Author(s) Disclosures</h3> The authors have no conflict of interest to disclose.