Financial Burden in Recipients of Allogeneic Hematopoietic Cell Transplantation

Abstract

Although allogeneic hematopoietic cell transplantation (HCT) is an expensive treatment for hematological disorders, little is known about the financial consequences for the patients who undergo this procedure. We analyzed factors associated with its financial burden and its impact on health behaviors of allogeneic HCT recipients. A questionnaire was retrospectively mailed to 482 patients who underwent allogeneic HCT from January 2006 to June 2012 at the Mayo Clinic, to collect information regarding current financial concerns, household income, employment, insurance, out-of-pocket expenses, and health and functional status. A multivariable logistic regression analysis identified factors associated with financial burden and treatment nonadherence. Of the 268 respondents (56% response rate), 73% reported that their sickness had hurt them financially. All patients for whom the insurance information was available (missing, n = 13) were insured. Forty-seven percent of respondents experienced financial burden, such as household income decreased by >50%, selling/mortgaging home, or withdrawing money from retirement accounts. Three percent declared bankruptcy. Younger age and poor current mental and physical functioning increased the likelihood of financial burden. Thirty-five percent of patients reported deleterious health behaviors because of financial constraints. These patients were likely to be younger, have lower education, and with a longer time since HCT. Being employed decreased the likelihood of experiencing financial burden and treatment nonadherence due to concern about costs. A significant proportion of allogeneic HCT survivors experience financial hardship despite insurance coverage. Future research should investigate potential interventions to help at-risk patients and prevent adverse financial outcomes after this life-saving procedure.

Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT

“…The incidence of severe late infections may, in turn, be affected by the local social conditions. As demonstrated by Khera et al in the Mayo Clinic population of alloHCT recipients, the procedure itself is associated with high financial burden [19]. Forty-seven percent of patients declared reduction of their income by greater than 50% due to loss of employment, insurance, out-of-pocket expenses, and deterioration of their health and functional status.…”

Late effects of blood and marrow transplantation

“…7,8 While no easy solutions are available, increased cost transparency and advance financial planning for patients may be helpful to prevent catastrophic events such as bankruptcy or loss of domicile.…”

Process of allogeneic hematopoietic cell transplantation decision making for older adults

“…[26][27][28] As many live on fixed incomes, financial matters are a real concern for older adults considering alloHCT. These include insurance coverage, medication copays and out-of-pocket costs for transportation and relocation, among others.…”

“…Khera et al 26 studied the financial burden of alloHCT and its impact on patients' health behaviors. Of the 268 survey respondents, 73% reported subjective financial burden related to their illness.…”