Patient-Reported Financial Toxicity Associated with Management of Nephrolithiasis

Published:January 25, 2023DOI:



      To characterize stone-related financial burden among adults with nephrolithiasis through validated questionnaires for financial toxicity.


      We performed a cross-sectional survey of adults with history of nephrolithiasis at an outpatient clinic. The survey contained a measure of stone-related financial toxicity (COST score), and assessed demographics, stone event history, and burden of overall, ancillary, preventative, and insurance costs. A COST score ≤ 21 was classified as high financial toxicity. Multivariable logistic regression was used to evaluate associations with demographic variables and stone event history.


      100 patients completed the survey (median age 57, IQR 48–64). The median COST score was 30 (IQR 23-37), and 19% reported high financial toxicity. Insurance status, household income, stone surgeries during lifetime and within the last 3 years were associated with financial toxicity on univariable analysis (p < 0.05). Burden of costs was significantly higher in all categories within the high financial toxicity cohort (each p < 0.05). On multivariable logistic regression, only income >$75,000 remained significant within the second model (OR 0.22, 95% CI 0.05 – 0.77, p = 0.02), however this relationship did not persist on the final model. When asked whether providers should be mindful of their financial situation prior to making treatment recommendations, 39% responded “quite a bit” or “very much.”


      1 in 5 patients seeking care for nephrolithiasis meet criteria for high financial toxicity. Financial toxicity was associated with household income, insurance, education, and frequency of stone events. 39% reported that their provider should be mindful of their financial situation when making recommendations.

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