AUTHOR=Esmaeili Aryan , Pogoda Terri K. , Amuan Megan E. , Garcia Carla , Del Negro Ariana , Myers Maddy , Pugh Mary Jo , Cifu David , Dismuke-Greer Clara 

TITLE=The economic impact of cannabis use disorder and dementia diagnosis in veterans diagnosed with traumatic brain injury

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1261144

DOI=10.3389/fneur.2023.1261144

ISSN=1664-2295

ABSTRACT=Background: Studies have demonstrated that individuals diagnosed with traumatic brain injury (TBI) frequently use medical and recreational cannabis to treat persistent symptoms of TBI, such as chronic pain and sleep disturbances, that can lead to cannabis use disorder (CUD). We sought to determine the Veterans Health Administration (VHA) healthcare utilization and costs associated with CUD and dementia diagnosis in veterans with TBI.: This observational study used administrative datasets from the population of Post-9/11 Veterans from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and VA Data Warehouse. We compared the differential VHA costs among the following cohort of veterans: 1) No CUD and No dementia diagnosis group, 2) Dementia diagnosis only, 3) CUD only, and 4) comorbid CUD and dementia diagnosis (Dementia & CUD). Generalized estimating equations and negative binomial regression models were used to estimate total annual costs (inflation-adjusted) and incidence rate of healthcare utilization, respectively, by dementia diagnosis and CUD status.Results: Data from 387,770 veterans with TBI (88.4% male; median [IQR] age at the time of TBI: 30 [14] years; 63.5% White) were followed from 2000 to 2020. Overall, we observed a trend of gradually increasing healthcare costs 5 years after TBI onset. Interestingly, in this cohort of veterans within 5 years of TBI, we observed substantial healthcare costs in the Dementia only group (peak= $46,808) that was not seen in the Dementia & CUD group. Relative to those without either condition, the annual total VHA costs were $3,368 higher in the CUD only group, while no significant differences were observed in the Dementia only and Dementia & CUD groups.: The findings suggest that those in the Dementia only group may be getting their healthcare needs met more quickly and within 5 years of TBI diagnosis, whereas veterans in the Dementia & CUD group are not receiving early care, resulting in higher long-term healthcare costs. Further investigations should examine what impact the timing of dementia and CUD diagnoses have on specific categories of inpatient and outpatient care in VA and community care facilities.