Health Care Costs Associated with Traumatic Brain Injury and Psychiatric Illness in Adults

Abstract

A cohort design was used to determine the contribution of traumatic brain injury (TBI) and psychiatric illness to health care costs for adolescents and adults in the 3 years following mild or moderate-to-severe TBI compared to a matched cohort without TBI, controlling for confounders. In all, 3756 subjects 15 years or older from a large health maintenance organization database were examined. We identified subjects who sustained a TBI in 1993 (n = 939) and selected three control subjects per TBI-exposed subject (n = 2817), matched for age, sex, and enrollment at the time of injury. Unadjusted mean costs in 2009-adjusted dollars were compared using Kruskal-Wallis tests and Mann-Whitney U tests, and adjusted mean costs were compared using gamma regression analyses. Average costs were 76% higher in the 3 years after injury for the mild TBI group, and 5.75 times greater for the moderate-to-severe TBI group compared to controls. The presence of psychiatric illness was associated with more than doubling of total costs for both inpatient and outpatient non-mental health care. Gamma regression analyses confirmed significantly higher costs in patients with TBI or psychiatric illness. A significant interaction between moderate-to-severe TBI and psychiatric illness indicated a 3.39 times greater cost among patients with both exposures compared with those exposed to moderate-to-severe TBI without psychiatric illness. TBI and psychiatric illness were each associated with significant increases in health care costs; those with the combination of moderate-to-severe TBI and psychiatric illness had much higher costs than any other group.

Rural‐urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

“…Patients with mTBI are hospitalized less frequently and are often treated exclusively on an outpatient basis. Due to limited data on outpatient utilization beyond the emergency department, few studies have described health care utilization and costs for mTBI . This is important because up to 30 percent of patients with mTBI experience ongoing symptoms (eg, cognitive fatigue, inattention, memory difficulties) for weeks to months after injury .…”

Telephone and In-Person Cognitive Behavioral Therapy for Major Depression after Traumatic Brain Injury: A Randomized Controlled Trial

“…[5][6][7][8][9] Psychosocial problems are often more predictive of poor outcomes than the physical sequelae of TBI in both civilian 10 and military 4 populations. Major depressive disorder (MDD) is the most prevalent psychiatric disorder accompanying TBI 7,8 and is associated with poorer health status, [11][12][13] including physical complaints, 11 cognitive [14][15][16][17][18] and social 14,19,20 problems, and increased costs 21 among persons with TBI.…”

Increased Risk of New-Onset Depression in Patients With Traumatic Brain Injury and Hyperlipidemia

“…1 It has become a major public issue for an estimated 3.17 million individuals in the United States 2 and was associated with 3.39 times the medical costs in TBI patients with psychiatric disorders compared to those without psychiatric disorders. 3 Among these psychiatric disorders, depression is the most common psychiatric complication of TBI and ranges from 6% to 77%, with variations according to the studied population and the diagnostic criteria or rating instruments used. [4][5][6][7] Depression is associated with a 3-fold increase of medical regimens in patients with chronic illness or comorbidities.…”