Out‐of‐Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States

Abstract

Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey (MEPS), we identified all families with ≥1 adult member with HF during 2014 – 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated two outcomes of financial toxicity: (1) high financial burden – total out‐of‐pocket healthcare expense to post‐subsistence income of >20%, and (2) catastrophic financial burden with the rate of >40% ‐ a bankrupting expense defined by the WHO. There were 788 families in MEPS with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%‐18%) of families experienced a high burden and 5% (95% CI, 3%‐6%) experienced a catastrophic burden. Among the two‐fifths of families considered low‐income, 24% (95% CI, 18%‐30%) experienced a high financial burden, while 10% (95% CI, 6%‐14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high (OR=3.9, 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR=14.2, 95% CI, 5.1–39.5) compared with middle/high income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.

Measures of Financial Hardship From Health Care Expenses Among Families With a Member With Atherosclerotic Cardiovascular Disease in the US

“…2 Moreover, the limited overlap of both domains highlights that other studies that focus on subjective financial hardship alone have not captured the scope of the economic challenges. 1,9 There have been previous reports of such a discordance in oncologic care, in which 16% to 73% of patients with cancer reported subjective financial hardship and 11% to 48% of patients reported objective financial hardship. 3,4 However, even in these oncology studies, objective and subjective financial hardship were often not concurrently measured in the same sources.…”

“…1 Objective financial hardship was considered present when a family spent 20% or more of their annual postsubsistence income as out-of-pocket medical costs. 2,9 Out-of-pocket medical costs were obtained and summed together at the family level. The spending categories included hospitalizations, outpatient visits, medications, emergency department visits, health insurance premium costs, and other out-of-pocket health care costs, including medical equipment.…”

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“…Finally, despite under‐inclusion in extant clinical guidance documents, 102 considerations of cost and value are increasingly important to consider at the bedside in an era of increasing HF‐related societal costs and patient‐level financial burden 103 . Financial toxicity occurs in a substantial proportion of patients with HF, and is associated with detrimental health impact 104,105 . Patients with HF are generally receptive to cost‐based conversations, 106 and discharge prescriptions should account for expected out‐of‐pocket costs after exhausting all possible opportunities for cost‐mitigation 52 .…”

“…103 Financial toxicity occurs in a substantial proportion of patients with HF, and is associated with detrimental health impact. 104,105 Patients with HF are generally receptive to cost-based conversations, 106 and discharge prescriptions should account for expected out-of-pocket costs after exhausting all possible opportunities for cost-mitigation. 52 Emerging pragmatic techniques, including a recently proposed spending function, 107 are potential conceptual frameworks to consider the patient-specific value of a new therapy.…”

Development and Validation of a Risk Score in Chinese Patients With Chronic Heart Failure

“…On the other hand, due to the new sedentary lifestyle, the incident of chronic cardiovascular diseases such as coronary heart disease, hypertension, diabetes, and obesity also increased. Heart failure is a serious late-stage event of cardiovascular diseases with high readmission and mortality rate ( 1 – 4 ). Meanwhile, the development of heart failure will eventually lead to adverse outcomes such as stroke and death ( 5 – 7 ).…”