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The costs of conflict: Amputees and the Afghan war

A long-term plan to budget for veterans' health care is necessary

Springer

Policy makers need to budget more than 288 million pounds over the next 40 years to adequately provide health care to all British soldiers who suffered amputations because of the Afghan war. This is the prediction of Major DS Edwards of the Royal Centre for Defence Medicine in the UK, in a new article appearing in the journal Clinical Orthopaedics and Related Research, published by Springer. He led a study into the scale and long-term economic cost of military amputees following Britain's involvement in Afghanistan between 2003 and 2014.

The authors describe the traumatic amputee as the hallmark of the wounded legacy from Afghanistan. This is in large part because of the extensive use of improvised explosive devices by insurgent groups against the coalition forces. Thanks to better personal protection equipment, improved early medical care, and rapid extraction of the injured, more service members survived such attacks. However, many now have to deal with complex wounds such as multiple amputations. Evidence after the Vietnam War suggests that such military amputees will need medical care and rehabilitation for more than 25 years after their initial injury.

Edwards and his colleagues set out to quantify the extent and nature of traumatic amputations suffered by British service staff from Afghanistan. This was done as a first effort to adequately start budgeting for the long-term needs of the injured beyond their years of service in the armed forces.

They found that between 2003 and 2014, 265 British soldiers sustained 416 amputations. On average the soldiers lost 1.6 limbs each. Of these, 153 soldiers lost their whole leg, while the lower leg of 143 patients was amputated. Including additional treatment cost and economic losses, the total cost or "disease burden" associated with these injuries could be higher than £288 million (USD 444 million) over the next 40 years. This translates to a lifetime cost of around 0.87 million pounds (or 1.34 million dollars) per single below knee military amputee. This is less than was calculated previously for American veterans, but more than the cost associated with civilian trauma amputees.

Over the next decades British military amputees will not only suffer from the same chronic health problems as that of the general population, but also have specific issues related to their injuries. This includes the use of prostheses. The authors believe these impacts can be modified by developing more effective and sustained medical and social support, post-military discharge, in order to encourage healthier lifestyles and develop people's skills and earning capacity. Therefore long-term financial commitment to health care, social services and resources, such as a single point of care, is needed.

"A long-term facility to budget for veterans' health care is necessary," say the authors. "Our estimates should be taken as the start of a challenge to develop sustained rehabilitation and recovery funding and provision."

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Reference: Edwards, D.S. et al (2015). What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort? Clinical Orthopaedics and Related Research. DOI 10.1007/s11999-015-4250-9

The full-text article is available to journalists on request.

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