Purpose Approximately 40% of men and 60% of women sustain an injury during U.S. Army basic combat training (BCT). These injuries impose significant costs on the Army. However, the economic costs of BCT-related injuries have never been quantified. This study estimated the direct medical costs to the Army of BCT-related injuries.

Methods The Total Army Injury and Health Outcomes Database (TAIHOD) was used to identify medical encounters for a cohort of trainees who started BCT from 2002 to 2007. Injury-related medical encounters were identified using International Classification of Diseases (ICD-9) diagnosis and procedure codes. Total direct medical cost per trainee was calculated by summing inpatient and outpatient costs. Injury related medical costs were estimated using an incremental cost analysis whereby medical costs of injured trainees were compared to medical costs of uninjured trainees, controlling for potential confounding variables using multiple regression.

Results Overall, the Army spent an average of $1200 on medical care per trainee over the study period. Injury status was the single largest predictor of costs. The mean medical cost per injured trainee was $1755, compared to $795 per non-injured trainee. Thus, for each injured trainee, the Army spent an additional $960, on average. After adjusting for other factors that affect costs, the mean additional cost of injury was estimated to be $872, which amounted to approximately $22 million per year. Mean costs varied by trainee characteristics, type of injury, and training location.

Conclusions BCT-related injuries impose enormous economic costs on the US Army. Variation in medical costs across training locations suggests that treatment practices also may vary. Further research is needed to identify specific factors that contribute to increased costs at certain locations and opportunities for reducing costs.

Significance and Contribution to Science This study provides a baseline estimate of the direct medical costs of BCT-related injuries.