New Study Gives Scope and Cost of Combat-Related Conditions Among Veterans

February 24, 2012 (New York Times) – It’s difficult to know just how many of the two million people who have served in the wars in Iraq and Afghanistan have been afflicted with two common combat ailments, post-traumatic stress disorder (P.T.S.D.) and traumatic brain injury (T.B.I.). But a new study of six years of data from the Veterans Health Administration, published this month by the Congressional Budget Office, illuminates not just the extent of the treatment that is needed, but its costs.

In a sampling of nearly half a million veterans of the two wars, 21 percent had P.T.S.D., 2 percent had symptoms of T.B.I., and 5 percent had both. For a variety of reasons, it’s hard to extrapolate these rates to the entire group of those who served.

But the notable finding of the report is this: Taken together, the afflicted group’s first-year treatment costs ran four to six times as high as patients without these conditions.

From 2004 to 2009, the Veterans Health Administration spent $3.7 billion on the first four years of care for all the veterans tracked by the study. Sixty percent of that sum, or $2.2 billion, went for the care of patients with P.T.S.D. or T.B.I., or both. About half of that went for therapies specific to P.T.S.D. and T.B.I.

In the first year of treatment, the cost of treating a typical patient with P.T.S.D. averaged $8,300, one with T.B.I. $11,700, and one with both $13,800. The average cost of the first year’s treatment for a patient with neither diagnosis was $2,400.

In patients diagnosed with P.T.S.D., the first year of treatment with the P.T.S.D.-specific therapy averaged $4,100, or nearly half of the $8,300 spent in total. In the second, third and fourth years of treatment, the average costs per patient went down, but the P.T.S.D. therapy continued to account for about half. The same pattern prevailed generally for patients with T.B.I. or with both problems – the highest costs come in the first year of treatment, costs generally decline in the next few years (once some technical wrinkles in the data are ironed out) and a significant portion of overall treatment costs are for these two conditions.

Total treatment costs were much higher, as would be expected, in one subset of about 500 patients whose injuries were much more far-reaching and who were treated as inpatients at a polytrauma rehabilitation center – about $136,000, on average, in the first year, $42,000 in the second year, $27,000 in the third year, $28,000 in the fourth year. About 95 percent of this group received treatment for P.T.S.D. or T.B.I. And in the polytrauma group, just as in the general Veterans Health Administration population, therapies for P.T.S.D. and T.B.I. accounted for 60 percent of total health care costs.

This somewhat dry and statistical treatment of a difficult subject is not a comprehensive accounting of the costs of these two war-related conditions. Many active-duty service members are treated by the Defense Department hospital system, not the veterans system, and many with these disorders receive treatment privately or not at all. Many who receive some treatment do not come back for enough sessions. But even though the budget office makes no recommendations – that’s not its function — there is valuable information in its study, and it is a reminder that the costs continue even as the wars wind down.

(To put the numbers in perspective, the Veterans Health Administration spent a total of $6 billion on health care expenditures for veterans of these wars from 2002 to 2010; total spending in 2010 alone for health care for veterans of all ages and all conflicts came to $48 billion. All dollar amounts are adjusted to 2011 values.)

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