The Cost of ALS Care within the Veterans Health Administration (P03.172)

Abstract

Objective: To determine the cost of Amyotrophic Lateral Sclerosis (ALS) care within the Veterans Health Administration (VHA). Background A 2006 report by the Institute of Medicine revealed that individuals that have served in the military have a 1.5 to 2 times increased risk of developing ALS. Based on this study, ALS became a compensable illness within the VHA in 2008. The cost of ALS care is considerable as patients require close monitoring of respiratory and nutritional needs as well as continued assessment of mobility and proper functional equipment. The VHA is a unique system in that patients receive all their care within a single payer system, which allows for reliable cost analysis. Design/Methods: Data was obtained retrospectively for fiscal years (FY) 2005-2010 from the Corporation Data Warehouse (CDW). Data merging and analysis were done through scrambled SSN; no patient identifiable information was used. ALS patients were identified by ICD-9 codes from the inpatient, outpatient and fee files. Results: There were 1522 patients with a diagnosis of ALS within the VHA in FY05 which increased to 2752 patients in FY10. The total cost of care increased from $35,890,466 to $114,288,333, respectively. The average total cost per patient in FY05 was $23,581 and $41,529 in FY10. The average inpatient, outpatient and fee basis costs per patient were $8,901, $11,566 and $3,115 in FY05, respectively. In FY10 these costs were $15,421, $19,272 and $6,836, respectively. Conclusions: The cost per patient and total cost of ALS care within the VHA has increased substantially from FY05 to FY10. The total cost dramatically increased in 2008 after ALS was declared a compensable illness. The cost per patient has also steadily increased, likely related to increased utilization of services within the VHA by veterans. The share of outpatient and inpatient costs in relation to overall total costs have remained stable. Disclosure: Dr. Khokhar has nothing to disclose. Dr. Patwa has nothing to disclose.