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The Impact of PTSD
One wild card in the process of estimating the lifetime cost of treating OEF/OIF veterans is the prevalence of PTSD, TBI and major depressive disorder (MDD) in this population. Discussed extensively at the Senate hearing was a Rand Corp. study in spring 2008 that found 18.4% of all returning servicemembers met criteria for PTSD or major depression. If this estimate applied across all 2.2 million OEF/OIF servicemembers, the number of new veterans returning with PTSD or depression would be more than 400,000.
PTSD adds significant cost to patient treatment. According to Rand, evidence-based PTSD care averages about $4,000 per year — in addition to other healthcare expenses. Co-morbid PTSD and MDD costs average $6,000 per year.
Costs for treating TBI are much more difficult to estimate, because the injury can affect such a wide range of physical functions. Because TBI and PTSD can be challenging to identify immediately after a servicemember returns home, the true prevalence of both conditions is currently unknown, making planning that much more difficult.
However, according to the Rand report, the greater costs would be from lost productivity among those patients not treated for these disorders. The cost from lost productivity is nearly 20 times the cost of the mental-health care for these patients.
Rand also estimated that half of those with probable PTSD or MDD had not been evaluated by VA in the year prior to their survey. This means they could present in the future, increasing VA’s resource need.
“The VA caseload is largely consisting of older veterans,” explained James Hosek, PhD, a Rand senior economist, at last month’s Senate hearing. “The immediate growth of the new generation of veterans is a challenge for [VA] because they need to adapt their provider mix. Those are [expected] growth problems.”
VA should investigate using resources and physicians available in the private sector if they cannot build up their own infrastructure soon enough to accommodate the needs of these new veterans, Hosek suggested.