Esmaeili Aryan, Pogoda Terri K, Amuan Megan E, Garcia Carla, Del Negro Ariana, Myers Maddy, Pugh Mary Jo, Cifu David, Dismuke-Greer Clara
Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States.
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States.
Front Neurol. 2024 Jan 12;14:1261144. doi: 10.3389/fneur.2023.1261144. eCollection 2023.
Studies have demonstrated that individuals diagnosed with traumatic brain injury (TBI) frequently use medical and recreational cannabis to treat persistent symptoms of TBI, such as chronic pain and sleep disturbances, which can lead to cannabis use disorder (CUD). We aimed to determine the Veterans Health Administration (VHA) healthcare utilization and costs associated with CUD and dementia diagnosis in veterans with TBI.
This observational study used administrative datasets from the population of post-9/11 veterans from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and the VA Data Warehouse. We compared the differential VHA costs among the following cohorts of veterans: (1) No dementia diagnosis and No CUD group, (2) Dementia diagnosis only (Dementia only), (3) CUD only, and (4) comorbid dementia diagnosis and CUD (Dementia and CUD). Generalized estimating equations and negative binomial regression models were used to estimate total annual costs (inflation-adjusted) and the incidence rate of healthcare utilization, respectively, by dementia diagnosis and CUD status.
Data from 387,770 veterans with TBI (88.4% men; median [interquartile range (IQR)] age at the time of TBI: 30 [14] years; 63.5% white) were followed from 2000 to 2020. Overall, we observed a trend of gradually increasing healthcare costs 5 years after TBI onset. Interestingly, in this cohort of veterans within 5 years of TBI, we observed substantial healthcare costs in the Dementia only group (peak = $46,808) that were not observed in the CUD and dementia group. Relative to those without either condition, the annual total VHA costs were $3,368 higher in the CUD only group, while no significant differences were observed in the Dementia only and Dementia and CUD groups.
The findings suggest that those in the Dementia only group might be getting their healthcare needs met more quickly and within 5 years of TBI diagnosis, whereas veterans in the Dementia and CUD group are not receiving early care, resulting in higher long-term healthcare costs. Further investigations should examine what impact the timing of dementia and CUD diagnoses have on specific categories of inpatient and outpatient care in VA and community care facilities.
研究表明，被诊断为创伤性脑损伤（TBI）的个体经常使用医用和消遣性大麻来治疗TBI的持续症状，如慢性疼痛和睡眠障碍，这可能导致大麻使用障碍（CUD）。我们旨在确定退伍军人健康管理局（VHA）对患有TBI的退伍军人中与CUD和痴呆症诊断相关的医疗保健利用情况及成本。
这项观察性研究使用了来自军事相关脑损伤联盟 - 神经创伤慢性影响联盟的9·11后退伍军人人群以及VA数据仓库的行政数据集。我们比较了以下退伍军人队列之间的VHA成本差异：（1）无痴呆症诊断且无CUD组，（2）仅痴呆症诊断组（仅痴呆症），（3）仅CUD组，以及（4）合并痴呆症诊断和CUD组（痴呆症和CUD）。分别使用广义估计方程和负二项回归模型来估计按痴呆症诊断和CUD状态划分的年度总成本（经通胀调整）和医疗保健利用发生率。
对387,770名患有TBI的退伍军人（88.4%为男性；TBI发生时的年龄中位数[四分位间距（IQR）]：30[14]岁；63.5%为白人）的数据从2000年至2020年进行了跟踪。总体而言，我们观察到TBI发病后5年医疗保健成本呈逐渐上升趋势。有趣的是，在TBI发病5年内的这组退伍军人中，我们在仅痴呆症组中观察到了大量医疗保健成本（峰值 = 46,808美元），而在CUD和痴呆症组中未观察到。相对于没有这两种情况的人，仅CUD组的年度VHA总成本高出3,368美元，而仅痴呆症组和痴呆症与CUD组未观察到显著差异。
研究结果表明，仅痴呆症组的人可能在TBI诊断后的5年内更快地满足了他们的医疗保健需求，而痴呆症与CUD组的退伍军人没有得到早期护理，导致长期医疗保健成本更高。进一步的调查应研究痴呆症和CUD诊断的时间对VA和社区护理机构中特定住院和门诊护理类别的影响。
