Introduction: Little is known regarding the financial burden of patients with kidney stone disease. We sought to characterize stone-related financial toxicity in among U.S. adults with kidney stones through validated questionnaires for financial toxicity and disease-specific health-related quality of life.
Methods: 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 75-item computer-based survey was administered to query stone event history and stone-related costs, the Wisconsin Stone related Quality of Life (WISQOL), and an 11-item measure of stone-related financial toxicity (COST score). Patients in the highest quartile COST score group were categorized as having high financial burden, and the lower 3 quartiles were categorized as having low financial burden. Multivariable logistic regression was performed to evaluate predictors of high financial burden.
Results: There were 262 responses were obtained, with median age 53 (IQR 41-63) years and 60% female (Table 1). Patients with high financial burden ($50; IQR 0-600) spent more out of pocket (OOP) than patients with low financial burden ($0; IQR 0-50; P<0.001) in past year on stone treatment, had more stone-related encounters (2 vs. 0; P<0.001) and were more likely to borrow money from family/friends to pay for treatment (13% vs. 1%; P<0.001). Patients with high financial burden were more likely to have a stone-related event or procedure in the last year (69% vs. 42%; P<0.001) and were more likely to defer recommended treatment due to anticipated cost (21% vs. 3%; P<0.001). Financial toxicity by COST score correlated with poorer stone related quality of life across WISQOL social, vitality, and disease impact domains (Table 1). Multivariable logistic regression (Table 1B) showed independent associations between high financial toxicity and poorer stone-related QOL in disease (P <0.001) and vitality (P=0.02) WISQOL domains.
Conclusions: In this national survey of adults with kidney stone disease, we found that financial toxicity as estimated by COST score was associated with disease-specific out of pocket costs, more frequent clinical encounters, deferral of recommended treatment, and poorer health-related quality of life.