**8. The economic argument in favor of coverage**

In what will be a ground-breaking analysis released on Veterans' Day, November 11, 2020, The TreatNOW Coalition, building on the seminal work done in 2011 [69], will update and expand the "true cost of ownership" to the American taxpayer of untreated brain injuries. Most studies attempting to estimate costs typically pay attention to the obvious cost categories – drugs, yearly health care costs, ER visits, hospitalizations, psychiatric care, home health care, long term care, lost wages, and sometimes even the impact on the family. TreatNOW has gone much further in examining the "ripple effect" through the family and into society.

The Study looks at impact on the family in categories such as physical and mental damage to immediate family members, including children and care-givers; social services for children affected by turmoil; and spousal suicides occasioned by violence and abuse. Divorce, homelessness, drug abuse, incarceration, death-bycop, and the estimated 135 people seemingly affected with every suicide [70].

A major "cost" to society beyond the medical expenditures are the tax implications of taking a brain-wounded citizen out of the work force. In too many cases, that actually equates to two lost incomes and taxes because a care-giver is typically a full-time aide to the wounded.

Brain Injury Facts about veterans are hard to pin down accurately since there are so much missing data. For example, the VA estimates that 70% of veterans are not part of the VA system. The VA also estimates TBIs alone for the period of 2000–2017 is over 414,000. RAND estimates that about one-third of all returning vets reported

**131**

*Hyperbaric Oxygenation in the Treatment of Traumatic Brain Injury*

symptoms of some mental health or cognitive condition. More recent estimates range up to 800,000+ for post-9/11, and an equal number of living veterans from service in the 20th century. Civilian casualties are estimated by the CDC as 2.5 million per year, with more than 5 million American effectively unemployable and

To summarize a much more robust analytical picture: untreated brain injuries cost billions of dollars each year when many of them could be reversed by application of HBOT to help heal the underlying and frequently ignored or misdiagnosed brain injury. It costs somewhere between \$40,000 and \$60,000 per year for each brain injured patient. HBOT treatment has shown an 85% probability of making a significant contribution to the health and welfare of treated patients, at a cost of approximately \$20,000. Thus, for less than 2% of the costs of sustaining the brain wounded on welfare, those brain injuries could be treated. The possibility of returning Quality of life and independence to a significant fraction of those wounded

Should further research be required before HBOT for TBI receives an indication, the Center for Medicare and Medicaid (CMS) issued Guidance for the Public, Industry, and CMS Staff, Coverage with Evidence Development, November 20, 2014 [71]. CMS and AHRQ declared that the principal purpose of the study would be to test whether the item or service (HBOT for TBI) meaningfully improves health outcomes of affected beneficiaries who are represented by the enrolled subjects. Unsurprisingly, the data and the demographics support immediate use of

It has been the experience of independent scientists over the last decade that peer-reviewed evidence from around the world attests to the safety and efficacy of HBOT in treating and helping to heal TBI and other neurological disorders. Yet the bulk of research on brain diseases and injury focuses on description and causes rather than treatments. Research into "treatments" is by design focused on treating symptoms. Clinical Practice Guidelines from the VA/DoD, for example, specifically focus on the "management" of concussion/mild traumatic brain injury [72]. Their CPG is a compendium of best practices for dealing with symptoms, not with healing or curing. No mention is made in the document of the wound to the brain, nor to healing that wound. And none of the treatments listed as standard of practice are

Unsurprisingly, huge sums are being poured into worldwide research, some coordinated, most in a competitive surge to devise better ways to understand the structure, function, aberrations and diseases, and treatments for the brain. The US (the Brain Initiative), Europe (Human Brain Project), Japan (Brain/MINDS Project), China (Brain Project), Israel, Australia and Canada have funded major projects [74]. Groups like One Mind and Paul Allen's Brain Institute are exploring how the brain works and what causes neurological disorders. While the projects vary slightly in their aims, the thrust is on knowledge rather than clinical medicine and healing. Longer-term goals of course include medicine to the patient. Yet precious little in all the efforts is being done to find immediate-use methods to inter-

vene in areas of wide and profound importance to human mental health.

*DOI: http://dx.doi.org/10.5772/intechopen.94401*

unable to perform activities of daily living.

is high.

HBOT.

**10. Conclusion**

approved by the FDA for treating TBI [73].

**9. Coverage with evidence**

#### *Hyperbaric Oxygenation in the Treatment of Traumatic Brain Injury DOI: http://dx.doi.org/10.5772/intechopen.94401*

symptoms of some mental health or cognitive condition. More recent estimates range up to 800,000+ for post-9/11, and an equal number of living veterans from service in the 20th century. Civilian casualties are estimated by the CDC as 2.5 million per year, with more than 5 million American effectively unemployable and unable to perform activities of daily living.

To summarize a much more robust analytical picture: untreated brain injuries cost billions of dollars each year when many of them could be reversed by application of HBOT to help heal the underlying and frequently ignored or misdiagnosed brain injury. It costs somewhere between \$40,000 and \$60,000 per year for each brain injured patient. HBOT treatment has shown an 85% probability of making a significant contribution to the health and welfare of treated patients, at a cost of approximately \$20,000. Thus, for less than 2% of the costs of sustaining the brain wounded on welfare, those brain injuries could be treated. The possibility of returning Quality of life and independence to a significant fraction of those wounded is high.
