Economic impact of comorbid TBI-dementia on VA facility and non-VA facility costs, 2000-2020

Objective There is evidence Traumatic Brain Injury (TBI) is associated with increased risk of dementia (D). We compared VA and non-VA facility costs associated with TBI+D and each diagnosis alone, relative to neither diagnosis, annually and over time, 2000-2020. Methods We estimated adjusted panel models of annual VHA costs in VA and non-VA facilities, stratified by age, and by TBI-dementia status. We also estimated cost for the TBI+D cohort by time since TBI and dementia diagnoses. All costs were 2021 inflation adjusted. Results Veterans <65 ($30,736) and >= 65 ($15,650) with TBI+D, while veterans <65 ($3,379) and >= 65 ($4,252) with TBI-only had higher annual total VHA costs, relative to neither diagnosis. Veterans with TBI+D < 65 ($42,864) and >= 65 ($72,424) had higher costs in years >= 15 after TBI diagnosis, while <65 ($36,431) and >= 65 ($37,589) had higher costs in years >= 10 after dementia diagnosis. Conclusions The main cost driver was inpatient non-VA facility costs. Veterans had continuously increasing inpatient care costs in non-VA facilities over time since their TBI and dementia diagnoses. Given budget constraints on the VA system, quality of care in non-VA facilities warrants comparison with VA facilities to make informed decisions regarding referrals to non-VA facilities.