Abstract
Objective
To characterize stone-related financial burden among adults with nephrolithiasis through
validated questionnaires for financial toxicity.
Methods
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.
Results
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.”
Conclusion
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.
Key words
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Article info
Publication history
Accepted:
January 2,
2023
Received:
October 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
