Dismuke-Greer C E, Gebregziabher M, Byers A L, Taber D, Axon N, Yaffe K, Egede L E
a Health Equity and Rural Outreach Innovation Center , Ralph H. Johnson VA Medical Center , Charleston , South Carolina , USA.
b Department of Internal Medicine , Medical University of South Carolina , Charleston , South Carolina , USA.
Brain Inj. 2018 Nov 7:1-7. doi: 10.1080/02699052.2018.1542508.
The U.S. Veterans Health Administration (VHA) provides depression treatment to veterans with Traumatic Brain Injury (TBI). VHA costs of comorbid TBI-depression were estimated by Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) status over 14 years.
VHA-USING veterans with TBI DIAGNOSED IN 2000-2010 were followed through FY2014. TBI severity was determined using the Department of Defense criteria. Depression was identified by the Elixhauser algorithm. Generalized linear and seemingly unrelated regression models were used to estimate the impact of depression on annual per veteran and total VHA inpatient, outpatient, and pharmaceutical costs, by OEF/OIF status.
A total of 66.57% of pre-OEF/OIF and 87.46% of OEF/OIF veterans had depression. Depression was estimated to increase annual total ($1,847), outpatient ($1,558), and pharmaceutical ($287) costs for pre-OEF/OIF, and $1,228, $1,685, and $191 for OEF/OIF veterans. However, depression was estimated to lower annual inpatient costs by $648 per OEF/OIF veteran. The annual VHA cost for all veterans with comorbid TBI-depression was estimated at $1,101,329,953.
The estimated annual cost for Veterans with comorbid TBI-depression was more than $1 billion. TBI and depression screening/treatment may result in reduced inpatient VHA costs in OEF/OIF veterans exposed to TBI. VHA policymakers should consider screening for TBI and depression in pre-OEF/OIF veterans.
美国退伍军人健康管理局（VHA）为患有创伤性脑损伤（TBI）的退伍军人提供抑郁症治疗。通过持久自由行动/伊拉克自由行动（OEF/OIF）状态，对14年间TBI合并抑郁症的VHA成本进行了估算。
对2000 - 2010年被诊断为TBI的VHA - USING退伍军人进行随访，直至2014财年。使用国防部标准确定TBI严重程度。通过Elixhauser算法识别抑郁症。使用广义线性模型和看似不相关的回归模型，按OEF/OIF状态估算抑郁症对每位退伍军人每年的费用以及VHA住院、门诊和药品总费用的影响。
在OEF/OIF之前的退伍军人中，共有66.57%患有抑郁症，在OEF/OIF退伍军人中这一比例为87.46%。据估计，抑郁症会使OEF/OIF之前的退伍军人每年的总费用（1847美元）、门诊费用（1558美元）和药品费用（287美元）增加，而对于OEF/OIF退伍军人，这三项费用分别增加1228美元、1685美元和191美元。然而，据估计，抑郁症会使每位OEF/OIF退伍军人的年度住院费用降低648美元。所有患有TBI合并抑郁症的退伍军人的年度VHA费用估计为1101329953美元。
患有TBI合并抑郁症的退伍军人的年度估计费用超过10亿美元。TBI和抑郁症筛查/治疗可能会降低遭受TBI的OEF/OIF退伍军人的VHA住院费用。VHA政策制定者应考虑对OEF/OIF之前的退伍军人进行TBI和抑郁症筛查。
