Introduction: “Financial toxicity” (FT) is the economic stress associated with the treatment of a condition. It includes direct/indirect costs and the cumulative effect on quality of life. FT is a patient-centered, clinically relevant outcome that has yet to be assessed in kidney stone treatment. This is the first study to characterize FT associated with the treatment of kidney stones.
Methods: We performed a cross-sectional cohort study. Adult patients treated for kidney stones in the Bronx, NY were surveyed using the validated COST tool (COmprehensive Score for financial Toxicity). The maximum score is 44 and lower scores indicate increased FT. Groups were defined as “moderate FT” for COST scores between 25-14 points and “severe FT” for scores <14 points based on prior studies. We analyzed FT scores by patient characteristics and stone disease history. Descriptive statistics, chi-square and ANOVA tests were performed using SPSS v27. Information on local financial aid programs was provided to all participants.
Results: 49 patients were surveyed. 59% of patients identified as Hispanic, and 86% identified as non-white including 25% Black and 16% Mixed-Race. Average age was 56.5 ± 14.4 years old. Average number of lifetime kidney stone events was 2.9 ± 2.6 and average number of lifetime kidney stone procedures was 1.0 ± 1.3. The mean number of workdays missed due to kidney stones in the last year was 5.5 ± 11.9 for patients and 1.5 ± 4.7 for family members, spouses, or friends due to aiding the patient. The median out-of-pocket cost for kidney stone treatment in the last year was <$100. Mean COST score for all patients was 24 ± 11. “Moderate FT” (score 25-14) was found in 41% of patients and “severe FT” (score <14) was found in 16%. Compared to those without FT, “moderate FT” and “severe FT” cohorts were comparable for number of kidney stone episodes, number of kidney stone procedures, days of work missed, type of insurance, level of education, race, gender, and age.
Conclusions: The majority of our patients reported moderate or severe FT. Prior studies have shown that patients with “moderate FT” employ cost-coping strategies (i.e., medication rationing) and those with “severe FT” have worse health outcomes. Urologists should investigate the financial context of their patients, educate themselves on the cost of treatments, and obtain informed financial consent. Understanding how treatment may affect financial well-being will allow for better shared decision making between patients and their urologists.