Major Medical Conditions and VA Healthcare Costs near End of Life for Veterans with Spinal Cord Injuries and Disorders

Article excerpt

INTRODUCTION

The United States has over 200,000 persons with traumatic spinal cord injuries (SCIs), and roughly 10,000 new cases are added each year [1-3]. Estimates of total annual costs of caring for patients with SCI in the United States have ranged from $7.74 to $9.45 billion (1995) [4-5]. The estimated costs (2006 dollars) during the first year following injury ranged from $741,425 a person with high tetraplegia to $218,504 for an incomplete injury at any level, and a person's lifetime costs ranged from $2.9 million for a high-level injury (e.g., a person injured at the age of 25) to $472,392 for an incomplete injury occurring at the age of 50 [6].

Limited research exists that examines the epidemiology and costs of nontraumatic spinal cord disorders. Frequent causes of spinal cord disorders include tumors, spinal stenosis, infections, ischemia, congenital disease, and myelitis [7]. Estimates of incidence of spinal cord disorders vary depending on the setting; approximately 29 percent of SCI admissions in a regional Model Systems program were nontraumatic [7]. Other studies have reported similar numbers [8-9]. For patients >40 years of age, however, Murray and Kusier found that 87 percent of patients had nontraumatic injuries [9]. Persons with nontraumatic injuries are reported to be older and more likely to be married than those with traumatic injuries [7].

The Department of Veterans Affairs (VA) cares for veterans with traumatic SCIs and for veterans with spinal cord disorders. They account for 22 percent of all individuals with SCI and disorders (SCI/Ds) in the United States [2]. Persons with SCI/D often experience impaired function and secondary complications resulting from their condition and need life-long interdisciplinary healthcare. Consequently, persons with SCI/D use substantial healthcare resources. Medical care for persons with SCI/D during their end of life is likely to be more intensive than for other patients. Similar to the general population, persons with SCI/D develop chronic illnesses as they age. However, because of the nature of their injury or impairment, they often experience these chronic illnesses at a younger age and/or have additional complications related to these medical conditions [10-11]. To our knowledge, limited literature is available about major medical conditions and costs near end of life for persons with SCI/D. In this article, we examined medical care costs and major conditions near end of life among veterans with SCI/D receiving care from the VA.

METHODS

We identified veterans with SCI/D who used the VA healthcare system during their final 24 months of life and died between October 1, 1999, and September 30, 2001 (fiscal years [FYs] 2000 and 2001). Following the definition developed by the VA SCI Quality Enhancement Research Initiative (QUERI), we classified veterans as SCI/D if the first four digits of their International Classification of Diseases-9 codes included 8060-8069, 9520-9524, 9528, 9529, 3441, 9072, or 3440 in their inpatient or outpatient records. After excluding 42 veterans (2%) who had utilization records that dated after their dates of death, we found that the final study cohort included 2,008 veterans with SCI/D who died in FY2000 or FY2001.

We used several VA data sets for this study: VA Beneficiary Identification and Records Locator Subsystem (BIRLS), VA National Patient Care Databases (NPCDs), VA Health Economics Resource Center Average Cost File (ACF), and the VA Spinal Cord Dysfunction (SCD) registry. Files from FY1998 through FY2001 were compiled to create 24 months (final 2 years) of data for each veteran in the study cohort. The BIRLS file contains information on veterans who obtain any benefits from VA and includes date of death, date of birth (DOB), and sex. The NPCD contains data on inpatient and outpatient care, including diagnoses, dates of services, and demographic information. …