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Van Houtven CH, Smith V, Stechuchak KM, Berkowitz TS, Shepherd-Banigan M, Hastings SN, Maciejewski ML, Miller K, Henius J, Campbell-Kotler M, Kabat M. Are there potential cost-offsets from comprehensive support of family caregivers? Impact on 3-year Veteran health care costs (Preliminary Results): Briefing before the VA Caregiver Support National Program Director (Margaret Kabat); 2017 Apr 24; Washington, DC.
Background. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) supports caregivers of Veterans from the post-9/11 era who need assistance with activities of daily living or supervision or protection because of the residual effect of injuries sustained or aggravated during their service. PCAFC provides services such as education and training, a monthly stipend paid to caregivers ($600-$2300/month depending on Veteran acuity), access to CHAMPVA for those without insurance coverage, mental health care, respite care and travel, lodging and subsistence. Since May 2011, more than 32,000 caregivers have been approved for PCAFC. A bill proposed by Senator Patricia Murray entitled, the Military and Veteran Caregiver Services Improvement Act of 2017 proposed extending the program to caregivers of Veterans of all eras; thus, even though the population of caregivers and Veterans from the post-9/11 era have unique characteristics compared to earlier era Veteran-caregiver dyads (e.g. younger, higher rates of traumatic brain injury, post-traumatic stress disorder, polytrauma, lower rates of dementia/Alzheimer's Disease), understanding long-term cost implications of PCAFC is vital to help inform this policy proposal. Objective. The purpose of this analysis was to examine the impact of PCAFC on 3-year Veteran health care costs. This analysis is a direct extension of our recent article examining the short-term impacts of PCAFC on Veteran health care costs (Van Houtven, Smith, et al., MCRR 2017). This analysis improves upon our past work because we now have 3 year costs for all persons who applied to PCAFC in the first 3 years of its existence. Results are preliminary because most recent VA claims are not yet fully populated. Methods. A pre-post cohort design with a non-equivalent control group was used to estimate differences in total VA health care costs of Veterans with caregivers enrolled in PCAFC and those with caregivers not enrolled in PCAFC in six month intervals for 3 years after application to PCAFC. The treatment group consisted of Veterans (n = 15,650) whose caregivers applied to and were approved for participation in PCAFC since its inception (May 2011) through March 2014. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC through March 2014 (n = 8,339). Results. Veterans in the PCAFC group were estimated to have $13,400 in VA health care costs in the first 6 months after PCAFC application compared to $11,058 in the control group. Over time, VA health care costs for both groups decreased, but the difference between groups persisted and remained statistically significant. At 3-years after PCAFC application (31-36 month interval in Figure), the Veterans in the PCAFC group were estimated to have $8,763 in health care costs compared to $6,613 in the control group. Estimated total VA health care costs for Veterans in the PCAFC group were on average $2,000 higher per 6-month interval than for Veterans in the control