High cost of healthcare for UK military amputees from Afghan conflict revealed

Researchers have calculated that £288 million is the cost of lifetime care for amputee veterans from the Afghanistan conflict.

Roadside bombs or improvised explosive devices (IEDs) were a leading cause of injury in UK armed forces personnel serving in the conflict in Afghanistan, which occurred between 2001 and 2014. More servicemen and women have been surviving blast injuries in recent years, thanks to better protection equipment, improved medical care and the rapid evacuation of casualties. However, surviving patients have complex wounds and the long-term medical and financial impacts of their injuries are still being investigated.

Researchers from The Royal British Legion Centre for Blast Injury Studies (CBIS) at Imperial College London have carried out a comprehensive analysis highlighting the extent and nature of amputations on British service personnel from the Afghan conflict and calculated the long-term healthcare costs. This is the first study to place a figure on the long-term cost of care for British amputees in this context.

The team say understanding the projected healthcare costs will enable policy makers to more adequately prepare for the needs of these veterans in the future. The study also sheds light on the continued research needed to understand the long-term impact of these blast injuries.

In the study, the researchers found that from the first roadside blast casualty in 2003, to the UK’s withdrawal in 2014, there were 265 casualties who sustained 416 amputations. The most common type of amputation from IEDs was above the knee, with 153 casualties, followed by 143 below the knee.

The team calculates that medical support for these veterans over an average remaining lifetime of 40 years will be approximately £288 million, when the combined cost of trauma care, rehabilitation and prosthetics are factored in.

However, the overall costs could climb even higher when factoring in: illnesses, not directly related to blast injuries; amputees receiving new prosthetics, following design improvements; and economic losses resulting in veterans being forced to drop out of the workforce due to their injuries.

The study, published today in the journal Clinical Orthopaedics and Related Research, highlights the need for policymakers to develop a long-term approach to caring for amputees.

Professor Anthony Bull, co-author of the study and Director of CBIS from Imperial College London, said:  “The Centre is focused on supporting the military to ensure the best care possible for veterans who have their lost limbs while serving their country. Understanding the cost implications is an important part of planning how to care for injured veterans in the long-term, in order to make their lives more comfortable. Ongoing evaluation of these injured soldiers will be needed to assess the level and specialisation of care required as they age. It is likely that these veterans will be subjected to chronic health problems experienced by the general population as well as specific issues as a result of their injuries. The lives of these servicemen and women could be improved if policymakers develop more effective and sustained medical and social support.

“Our research is a great example of scientists from the Blast Centre and Ministry of Defence working together to shed light this massively important issue. However, we still have a very long way to go to understand the long-term impact that these injuries have on our servicemen and women. That is why we are working with The Royal British Legion and the Government to carry out more research in this field.”

Sue Freeth, The Royal British Legion’s Director of Operations, said: "This is the first attempt we know of to publish an independent estimate of the lifetime health care cost of the British service personnel seriously injured by IEDs in Afghanistan. The Legion has been concerned for some time that the lifetime care of seriously injured veterans was under estimated. This paper should alert health commissioners to the scale of the problem, and help them to plan ahead to meet the lifetime health care needs of this generation. Many of the injured veterans from Afghanistan have survived only because of the innovation of modern military and NHS medicine and medics on the battlefield, and the need for a lifetime of health care to support them is in danger of being over looked as the spot light moves away from this conflict."

A breakdown of the healthcare costs by the researchers show the base cost over 40 years of single amputees was £0.87 million ($US 1.34 million) for a transtibial or below the knee amputees, £1.16 million ($US1.79 million) for a through-knee amputee, and £1.16 million ($US1.79million) for a transfemoral or above the knee amputees.

The researchers compared their costs to a study carried in 2010, which shows the estimated healthcare budget needed for US amputee veterans from the Afghan conflict. The study showed the lifetime cost of healthcare for veterans who had lost an arm was $US 0.82 million, $US 1.46 million for veterans who had lost a leg, $US 2.12 million those who had lost both arms and $US 2.90 million for multiple limbs.

To carry out the study, the researchers used a four part methodology. This included analysing previous studies on the cost of amputee care in the UK; using an economic model to estimate the cost for long-term healthcare costs of veterans; and carrying out a statistical cost comparison between British veterans from Afghanistan and veterans from previous conflicts such as the Vietnam War. They also did a retrospective investigation of trauma-related amputations recorded in the UK Joint Theatre Trauma and Prosthetic database, which belongs to the Ministry of Defence.

CBIS researchers are now collaborating on a study with the British Military and King’s College London to investigate the health and well-being of veterans over a 20 year period. The aim is to find ways of improving the long-term support for people who have sustained blast injuries.

The Royal British Legion Centre for Blast Injury Studies (CBIS) is the first collaboration of its kind in the UK, where civilians including engineers and scientists are working alongside military doctors, supported by charitable funding, to improve protective gear and develop better treatments for people injured from roadside bombs or IEDs.

See the press release of this article