What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?

Abstract

BackgroundPersonal protection equipment, improved early medical care, and rapid extraction of the casualty have resulted in more injured service members who served in Afghanistan surviving after severe military trauma. Many of those who survive the initial trauma are faced with complex wounds such as multiple amputations. Although costs of care can be high, they have not been well quantified before. This is required to budget for the needs of the injured beyond their service in the armed forces.Question/purposesThe purposes of this study were (1) to quantify and describe the extent and nature of traumatic amputations of British service personnel from Afghanistan; and (2) to calculate an estimate of the projected long-term cost of this cohort.MethodsA four-stage methodology was used: (1) systematic literature search of previous studies of amputee care cost; (2) retrospective analysis of the UK Joint Theatre Trauma and prosthetic database; (3) Markov economic algorithm for healthcare cost and sensitivity analysis of results; and (4) statistical cost comparison between our cohort and the identified literature.ResultsFrom 2003 to 2014, 265 casualties sustained 416 amputations. The average number of limbs lost per casualty was 1.6. The most common type of amputation was a transfemoral amputation (153 patients); the next most common amputation type was unilateral transtibial (143 patients). Using a Markov model of healthcare economics, it is estimated that the total 40-year cost of the UK Afghanistan lower limb amputee cohort is £288 million (USD 444 million); this figure estimates cost of trauma care, rehabilitation, and prosthetic costs. A sensitivity analysis on our model demonstrated a potential ± 6.19% variation in costs.ConclusionsThe conflict in Afghanistan resulted in high numbers of complex injuries. Our findings suggest that a long-term facility to budget for veterans’ health care is necessary.Clinical RelevanceEstimates here should be taken as the start of a challenge to develop sustained rehabilitation and recovery funding and provision.

Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace

“…These interventions could have a great impact on resource utilization as patients managed following principles of DCR may require a longer intensive care unit and hospital stay and thus, higher medical resources and costs. As for complications, previous studies have investigated the impact of war on medical and economic resources [23][24][25] . For example, Edwards et al 24 , calculated the long-term cost of traumatic amputations of British personnel from Afghanistan and found that the total cost of 265 casualties that sustained a total of 416 amputations would be higher than USD 444 million over forty years.…”

“…As for complications, previous studies have investigated the impact of war on medical and economic resources [23][24][25] . For example, Edwards et al 24 , calculated the long-term cost of traumatic amputations of British personnel from Afghanistan and found that the total cost of 265 casualties that sustained a total of 416 amputations would be higher than USD 444 million over forty years. Masini et al 25 , showed that combat-related extremity injuries require the greatest utilization of resources for inpatient treatment, are responsible for a higher burden of disabled soldiers, and have the most significant projected disability benefit costs.…”

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions

“…Edwards et al predicted the long-term (40 year) cost of trauma repair, rehabilitation, and lifelong prosthetic support of British soldiers wounded in Afghanistan to be approximately $444 million. 21 In the United States, the estimated average lifetime cost of treatment for unilateral lower LL is $342,716 and $1.4 million for Vietnam and OIF/OEF veterans, respectively.22 However, such estimates are likely conservative, not fully accounting for costs associated with novel technology/repairs or, perhaps exponentially more economically burdensome over the longer term, for the wide range of healthcare costs associated with the treatment of secondary health conditions. The ability to evaluate, predict, and ultimately treat these resultant health conditions would not only help reduce these costs but also, and most importantly, preserve and/or improve function and QoL for those with LL and LS.…”

Introductory Chapter: Toward Near-Natural Assistive Devices

“…Of this total, an individual will spend $181,500 on prosthetics at approximately $10,232 per unit [13]. These costs are also corroborated in several unrelated studies on civilian and veteran lower limb amputation costs [5,19]. Similar estimates for upper limb amputations are not readily available in the literature.…”