Department of Defense Military Treatment Facility and Community Care Costs After Traumatic Brain Injury in Service Members and Veterans Treated in Veterans Affairs Polytrauma Rehabilitation Centers: A VA TBI Model Systems Study.

Objective: To estimate cost models of military traumatic brain injury (TBI) that can provide evidence for future cost-effectiveness analyses highlighted as a gap in the recent National Academies of Sciences, Engineering, and Medicine (NASEM) report on accelerating progress in TBI.

Setting: Military Treatment Facilities (MTFs) and community care facilities within the Military Health System (MHS).

Participants: 1,101 service members/veterans (SMV) diagnosed with a TBI and treated at a Veterans Administration (VA) Polytrauma Rehabilitation Center (PRC).

Design: This retrospective study analyzed healthcare costs in MTFs and community care facilities among SMVs diagnosed with TBI and treated at 1 of 5 VA PRCs. MTF and community care records were assessed.

Main Measures: Annual MTF and community care inpatient and outpatient costs. TBI disability was measured by the Disability Rating Scale (DRS).

Results: Mean age was 31, with 9.8 years of service, and time in MHS post-TBI was 7.18 years. The mean annual inpatient cost was $22,126 in MTFs and $112,218 in community. The mean annual outpatient cost was $17,983 in MTFs and $9,141 in community. Each year of age was associated with $8,276 (95% CI 4,068-12,483), each day of acute care length of stay (LOS) before rehabilitation with $1,024 (95% CI 8-2039), and each additional point on the DRS with $10,858 (95% CI 4,273-17,442) higher costs.

Conclusion: Findings describe MHS annualized costs across acute and chronic stages in MTFs and the community and their association with SMVs' TBI disability measured by the DRS. These foundational cost data are critical for informing future hybrid design trials in TBI that examine the economic impact of TBI interventions being studied in future research.