Cost analysis examining the excess healthcare costs among Veterans who had a non-fatal firearm injury between 2010 and 2019.

Objective: Veterans are disproportionately affected by firearm injury (FAI). Beyond the human toll of FAIs, they also strain healthcare systems. This study examined excess costs from FAIs incurred by the Veterans Affairs (VA) Healthcare System among a cohort of VA-using Veterans.

Methods: Using International Classification of Diseases external cause-of-injury codes from VA administrative data, we identified Veterans with non-fatal FAI visits between 2010 and 2019 ('cases'). We matched cases to two uninjured Veterans 'controls' by cost-relevant characteristics (eg, a prediction score of future healthcare costs). Average VA healthcare costs were calculated for all Veterans 1 year post-index date and were compared between cases and controls and by Veteran and injury characteristics. Sensitivity analyses examined characteristics and costs for cases who were not matched to controls.

Results: The sample (N=30 624) consisted of cases (n=10 208) and their matched controls (n=20 416). Average healthcare costs for cases were 2.1 times higher than for controls (US$31 049 vs US$14 685), resulting in mean excess healthcare costs of US$16 364 per case in the year following their index date. Injuries categorised as intentional were associated with two times the excess cost of injuries categorised as unintentional (US$23 049 vs US$11 190).

Conclusion: The cost of providing care for Veterans in the year following an FAI was over two times as high as for similar Veterans without an FAI. Costs varied by intent. The excess costs reported in this study are conservative estimates of the true costs that the VA paid in the year post-injury. Policy implications are discussed.