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Patient-Reported Financial Toxicity Associated with Management of Nephrolithiasis

Published:January 25, 2023DOI:https://doi.org/10.1016/j.urology.2023.01.010

      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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      References

        • Hill AJ
        • Basourakos SP
        • Lewicki P
        • Wu X
        • Arenas-Gallo C
        • Chuang D
        • et al.
        Incidence of Kidney Stones in the United States: The Continuous National Health and Nutrition Examination Survey.
        J Urol. 2022 Apr; 207: 851-856
        • Pearle MS
        • Calhoun EA
        • Curhan GC
        Urologic Diseases of America Project. Urologic diseases in America project: urolithiasis.
        J Urol. 2005 Mar; 173: 848-857
        • Moe OW.
        Kidney stones: pathophysiology and medical management.
        Lancet Lond Engl. 2006 Jan 28; 367: 333-344
        • Kirkali Z
        • Rasooly R
        • Star RA
        • Rodgers GP.
        Urinary Stone Disease: Progress, Status, and Needs.
        Urology. 2015 Oct; 86: 651-653
        • Caldwell N
        • Srebotnjak T
        • Wang T
        • Hsia R.
        “How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department.
        PLoS ONE. 2013 Feb 27; 8: e55491
        • Saigal CS
        • Joyce G
        • Timilsina AR
        • Urologic Diseases in America Project
        Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management?.
        Kidney Int. 2005 Oct; 68: 1808-1814
        • Dauw CA
        • Kaufman SR
        • Hollenbeck BK
        • Roberts WW
        • Faerber GJ
        • Wolf JS
        • et al.
        Expulsive therapy versus early endoscopic stone removal in patients with acute renal colic: a comparison of indirect costs.
        J Urol. 2014 Mar; 191: 673-677
        • Quarrier S
        • Li S
        • Penniston KL
        • Best SL
        • Hedican SP
        • Jhagroo RA
        • et al.
        Lower Socioeconomic Status is Associated With Adverse Urinary Markers and Surgical Complexity in Kidney Stone Patients.
        Urology. 2020 Dec 1; 146: 67-71
        • Bayne D
        • Hicks CR
        • Srirangapatanam S
        • Armas-Phan M
        • Maru J
        • Gennatas E
        • et al.
        Underinsurance And Multiple Surgical Treatments for Kidney Stones.
        Urology [Internet]. 2022 Sep 25; ([cited 2022 Oct 9]; Available from:)
        • Wan C
        • Williams CP
        • Nipp RD
        • Pisu M
        • Azuero A
        • Aswani MS
        • et al.
        Treatment Decision Making and Financial Toxicity in Women With Metastatic Breast Cancer.
        Clin Breast Cancer. 2021 Feb; 21: 37-46
        • Zafar SY
        • Chino F
        • Ubel PA
        • Rushing C
        • Samsa G
        • Altomare I
        • et al.
        The utility of cost discussions between patients with cancer and oncologists.
        Am J Manag Care. 2015 Sep; 21: 607-615
        • Ver Hoeve ES
        • Ali-Akbarian L
        • Price SN
        • Lothfi NM
        • Hamann HA.
        Patient-reported financial toxicity, quality of life, and health behaviors in insured US cancer survivors.
        Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2021 Jan; 29: 349-358
        • de Souza JA
        • Yap BJ
        • Hlubocky FJ
        • Wroblewski K
        • Ratain MJ
        • Cella D
        • et al.
        The development of a financial toxicity patient-reported outcome in cancer: The COST measure.
        Cancer. 2014 Oct 15; 120: 3245-3253
        • de Souza JA
        • Yap BJ
        • Wroblewski K
        • Blinder V
        • Araújo FS
        • Hlubocky FJ
        • et al.
        Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST).
        Cancer. 2017 Feb 1; 123: 476-484
        • Imber BS
        • Varghese M
        • Ehdaie B
        • Gorovets D.
        Financial toxicity associated with treatment of localized prostate cancer.
        Nat Rev Urol. 2020 Jan; 17: 28-40
        • Stone BV
        • Laviana AA
        • Luckenbaugh AN
        • Huang LC
        • Zhao Z
        • Koyama T
        • et al.
        Patient-Reported Financial Toxicity Associated with Contemporary Treatment for Localized Prostate Cancer.
        J Urol. 2021 Mar 1; 205: 761-768
        • Ezeife DA
        • Morganstein BJ
        • Lau S
        • Law JH
        • Le LW
        • Bredle J
        • et al.
        Financial Burden Among Patients With Lung Cancer in a Publically Funded Health Care System.
        Clin Lung Cancer. 2019 Jul; 20: 231-236
        • Biddell CB
        • Kasow KA
        • Killela MK
        • Page KM
        • Wheeler SB
        • Drier SW
        • et al.
        Understanding the financial and psychological impact of employment disruption among caregivers of pediatric HSCT recipients: a mixed methods analysis.
        Support Care Cancer. 2022; 30: 4747-4757
        • Honda K
        • Gyawali B
        • Ando M
        • Kumanishi R
        • Kato K
        • Sugiyama K
        • et al.
        Prospective Survey of Financial Toxicity Measured by the Comprehensive Score for Financial Toxicity in Japanese Patients With Cancer.
        J Glob Oncol. 2019 May 9; 5 (JGO.19.00003)
        • Staehler MD
        • Battle DJ
        • Bergerot CD
        • Pal SK
        • Penson DF.
        COVID-19 and financial toxicity in patients with renal cell carcinoma.
        World J Urol. 2021 Jul; 39: 2559-2565
        • Hazell SZ
        • Fu W
        • Hu C
        • Voong KR
        • Lee B
        • Peterson V
        • et al.
        Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life.
        Ann Oncol Off J Eur Soc Med Oncol. 2020 Jan; 31: 96-102
        • Ragavan M
        • Parikh D
        • Patel M.
        Defining the clinician's role in mitigating financial toxicity: an exploratory study.
        Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2021 Aug; 29: 4835-4845
        • Dean Assimos
        • Amy Krambeck
        • Miller Nicole L.
        • Manoj Monga
        • Hassan Murad M.
        • Nelson Caleb P.
        • et al.
        Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I.
        J Urol. 2016 Oct 1; 196: 1153-1160
        • Pearle Margaret S.
        • Goldfarb David S.
        • Assimos Dean G.
        • Gary Curhan
        • Denu-Ciocca Cynthia J.
        • Matlaga Brian R.
        • et al.
        Medical Management of Kidney Stones: AUA Guideline.
        J Urol. 2014 Aug 1; 192: 316-324
        • Babjuk M
        • Burger M
        • Compérat E
        • Gontero P
        • Mostafid AH
        • Palou J.
        EAU Guidelines.
        in: Edn. presented at the EAU Annual Congress Amsterdam 2020. EAU Guidel Off Arnh Neth, 2020
        • Meropol NJ
        • Schrag D
        • Smith TJ
        • Mulvey TM
        • Langdon RM
        • Blum D
        • et al.
        American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care.
        J Clin Oncol. 2009 Aug 10; 27: 3868-3874