To characterize stone-related financial toxicity among U.S. adults with kidney stones through validated questionnaires for financial toxicity and disease-specific health-related quality of life.
We performed a cross-sectional survey of adults with kidney stone disease from the general population ascertained through a national registry of volunteers (ResearchMatch). A computer-based survey queried stone event history and related costs for medical care, disease-specific quality of life (WISQOL), and an 11-item measure of stone-related financial toxicity (COST-11 score). Multivariable logistic regression was performed to evaluate predictors of financial toxicity, defined as having a COST-11 score ≤20.
Of 942 responses, median COST-11 score was 29 (IQR 21-38), and 24.7% (N=233) met criteria for disease-specific financial toxicity. Stone-formers with financial toxicity spent more out of pocket on stone-treatment in the previous year than patients with lower financial burden (P<0.001) and were more likely to defer or delay recommended treatment due to anticipated cost (27% vs. 3%; P<0.001). Stone-specific financial toxicity was associated with poorer disease-specific health-related quality of life across all WISQOL domains (each P<0.001). Multivariable logistic regression showed that female gender (OR 1.81; 95% CI 1.24-2.67), Medicaid compared to private insurance (OR 3.91; 95% CI 2.34-6.94), and stone passage in the previous year (OR 2.00; 95% CI 1.41-2.86) were independently associated with financial toxicity.
Approximately one in four individuals with kidney stone disease report disease-specific financial toxicity. These data suggest the financial burden of the condition may influence decision-making and associates with poorer disease-specific quality of life.
Urology. 2022 Oct 14 [Epub ahead of print]
Jackson Cabo, David G Gelikman, Ryan S Hsi
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: ., College of Medicine, University of Central Florida, Orlando, Florida, USA. Electronic address: ., Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: .