Journal of Rehabilitation Research & Development (JRRD)

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Volume 52 Number 6, 2015
   Pages 827 — 838

Abstract — Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends

Vibha Bhatnagar, MD, MPH;1* Erin Richard, MPH;1 Ted Melcer, PhD;2 Jay Walker, BS;2 Michael Galarneau, MS, NREMT2

1Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA; and Department of Veterans Affairs San Diego Healthcare System, San Diego, CA; 2Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA

Abstract — Department of Veterans Affairs (VA) outpatient costs were analyzed for combat Veterans injured in Iraq and Afghanistan from 2001 to 2008. Patients had serious lower-limb injuries (n = 170) or unilateral (n = 460) or bilateral (n = 153) lower-limb amputation(s). Total costs over the follow-up period (2003 to 2012) and annual costs were analyzed. Unadjusted mean costs per year in 2012 U.S. dollars were $7,200, $14,700, and $18,700 for limb injuries and unilateral and bilateral lower-limb amputation(s), respectively (p < 0.001). Multivariate modeling indicated that annual cost declined after the first year in the VA for Veterans with limb injuries (p < 0.001, repeated measures). In contrast, annual costs doubled after 3–5 years with unilateral (p < 0.001) and bilateral amputation(s) (p < 0.001). Among amputees, prosthetics comprised more than 50% of outpatient cost; unadjusted mean cost per year for prosthetics was 7–9 times higher in comparison with Veterans with limb injuries. Amputation status was associated with an adjusted 3.12-fold increase in mean prosthetic cost per year (p < 0.001, general linear model). In addition, posttraumatic stress disorder (PTSD) was associated with increased prosthetic cost by amputation status (p < 0.001) and increased psychiatric and pharmacy costs (both p < 0.001). Results indicate relatively high and sustained outpatient costs driven by prosthetics following amputation. Finally, PTSD affected cost for multiple domains of health, highlighting the importance of accurate diagnosis, treatment, and support for PTSD.

Key words: amputation, amputee, Department of Veterans Affairs, Expeditionary Medical Encounter Database, outpatient cost, pharmacy, posttraumatic stress disorder, prosthetic, psychiatry, rehabilitation, utilization.


View HTML ¦ View PDF ¦ Contents Vol. 52, No.7

This article and any supplementary material should be cited as follows:
Bhatnagar V, Richard E, Melcer T, Walker J, Galarneau M. Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends. J Rehabil Res Dev. 2015;52(7):827–38.
http://dx.doi.org/10.1682/JRRD.2014.11.0288
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