The cost of injury to the Australian army

Abstract

This thesis is the first study to have determined a comprehensive estimate of the cost of injury to the Australian Army. The approach used was that of a cost of illness study, which summarised the economic burden of injury and provides information for stakeholders, allowing them to make informed decisions on the allocation of scarce healthcare resources. Cost of illness (COI) studies serve a different purpose to that of health economic evaluations which are focused on evaluating the cost of an intervention rather than estimating the cost of a particular disease. A "top down" approach to analysis was adopted utilising high level organisational databases to obtain cost data. This thesis adopted the primary perspective of government, but also considered costs from a societal and individual perspective. Estimating the economic burden of injury in a defined population is dependant on the availability of data of sufficient quality and scope, which is often lacking. This was the case in this thesis where available datasets contained data of poor quality or insufficient detail to provide accurate injury cost data. A number of assumptions were required in order to develop estimates of the contribution of injury to different sources of cost. There is a clear requirement for Defence to improve it injury surveillance and introduce an electronic health record to facilitate this. Efforts must also be made to link clinical data with cost data to better inform decision makers about the relative benefits achieved from the considerable cost resulting from injury. The cost of injury has three components; direct costs; indirect costs; and intangible costs. Direct costs considered in this analysis included external medical and compensation costs, as well as compensation liabilities calculated by the Australian Government Actuary. Indirect costs included productivity losses, with invalid pensions also included because they constitute a significant cost to Government not usually included in (COI) studies. An additional analysis of the net present value of lost wages was conducted on those soldiers who were invalided from the Army. A novel approach, termed the Capital Investment Model, was used to estimate the loss of training investment as a result of premature separation from the Army due to injury. Intangible costs were not included in this study because of the difficulty in placing a monetary value on these aspects of injury. Direct injury costs in 1996 were estimated to be between $40.75 and $42.36M with outstanding compensation liabilities of $270M. Indirect costs were estimated to be $10.74M with invalid pension liabilities of $63.82M. Capital losses due to premature separation from the Army due to injury were estimated to be $10.1 OM. The total cost of injury to the Australian Army (in 1996 dollars) was estimated to be between $61.59M and $63.20M, with estimated pension and compensation liabilities of $333.82M. Injury causes a significant financial impost. This is also the first study to compare the cost and outcomes of a range of spinal surgical procedures reflective of general orthopaedic community practice. It adopted a "bottom up" approach to analysis, where detailed data was obtained from individual records and a patient survey. This allowed for outcome and cost analysis by subgroup. A number of findings were consistent with the literature, in particular the dissociation between pain score and functional capacity. Increasing complexity of surgical intervention increased costs with no improvement in clinical outcome and alarming levels of radiological exposure was found. Radiation exposure could not be compared to other studies as they did not report the distribution of radiological investigations. The decision to undergo surgery appears to be based on the baseline level of pain and the fear of it worsening rather than specific clinical indications. The use of effective nonoperative methods of reducing pain offers the prospect of significantly reducing the patient demand for surgery and its attendant cost. The greatest injury-related cost savings from a societal perspective are obtained from interventions that promote early return to work and minimize lost productivity. Preventing an injury prevents the associated cost, so efforts in the area of injury prevention are critical in reducing the burden of injury. The significant reduction in injury observed from the Defence Injury Prevention Program highlights the benefit of effective primary prevention programs. Equally, once an injury occurs, secondary prevention efforts seek to achieve maximum restoration of function with minimal morbidity and cost. The results of the spinal surgery study have shown that improvement in primary outcome measures are not effect by the cost of the chosen intervention and efforts to achieve pain relief through non-operative means,in order to prevent surgical intervention, should be a high priority for research, not just in Army but in the broader community. Show more