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

Clara E. Dismuke-Greer, Aryan Esmaeili, Amol M. Karmarkar, Boyd Davis, Carla Garcia, Mary Jo Pugh, Kristine Yaffe

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)673-682
Number of pages10
JournalBrain Injury
Issue number5
StatePublished - 2022
Externally publishedYes


  • Traumatic brain injury
  • cost
  • dementia
  • military
  • veterans

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Developmental and Educational Psychology
  • Clinical Neurology


Dive into the research topics of 'Economic impact of comorbid TBI-dementia on VA facility and non-VA facility costs, 2000-2020'. Together they form a unique fingerprint.

Cite this