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Abstract-This study projects prosthetic- and assistive-device costs for veterans with limb loss from Vietnam and injured servicemembers returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) to inform the Department of Veterans Affairs (VA) for these veterans' future care. The 2005 Medicare prosthetic device component prices were applied to current prosthetic and assistive-device use obtained from a national survey of 581 veterans and servicemembers with major traumatic amputations. Projections were made for 5-year, 10-year, 20-year, and lifetime costs based on eight Markov models. Average 5-year projected costs for prosthetic and assistive-device replacement for the Vietnam group are lower than for the OIF/OEF cohort due in part to use of fewer and less technologically advanced prosthetic devices and higher frequency of prosthetic abandonment. By limb-loss level, for the Vietnam group and OIF/OEF cohort, 5-year projected unilateral upper limb average costs are $31,129 and $117,440, unilateral lower limb costs are $82,251 and $228,665, and multiple limb costs are $130,890 and $453,696, respectively. These figures provide the VA with a funding estimate for technologically advanced prosthetic and assistive devices within the framework of ongoing rehabilitation for veterans with traumatic limb loss from the Vietnam and OIF/OEF conflicts.
Key words: amputation, assistive device, cost projection, costs, limb loss, Markov model, OIF/OEF, prosthetics, rehabilitation, Vietnam.
Abbreviations: ASR = age-sex-race-adjusted (death rates), DOD = Department of Defense, DSS = Decision Support System, MFCL = Medicare Functional Classification Level, OEF = Operation Enduring Freedom, OIF = Operation Iraqi Freedom, USD = United States dollar, VA = Department of Veterans Affairs.
INTRODUCTION
The Department of Defense (DOD) Rehabilitation Directive aims to return servicemembers with limb loss from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) to preinjury function and provide the option of returning servicemembers to Active Duty. As of June 2008, the DOD Amputee Patient Care Programs at Walter Reed Army Medical Center (Washington, DC), Brooke Army Medical Center (San Antonio, Texas), and Naval Medical Center (San Diego, California) have provided nearly 1,000 servicemembers with state-of-the-art comprehensive rehabilitation care, including the provision of advanced technology, prosthetic and assistive devices, and training to restore function to the extent possible [1].* Servicemembers who benefit from these services continue to transition to the Department of Veterans Affairs (VA), where the prosthetic-device...