Financial burden among liver transplant candidates is associated with financial distress and work impairment: A U.S. multicenter study
Elizabeth S. Aby, Melanie Hundt, Jonathan Rice, Mike Kriss, Kali Zhou, Lauren Nephew, Sarah R. Lieber, Alvaro Noriega Ramirez, Brett E. Fortune, Clara Tow, Paola Mejia, Deepika Devuni, Anita Krisharao, Shari Rogal, Alan Noll, Stela Celaj, Nathaly Cortez Bazan, Patricia Jones, Hersh Shroff, Krista Hunt, Areej Mazhar, Dempsey Hughes, Jackie B. Henson, Lindsay Y. King, Thomas M. Leventhal, Enya Zhu, Grace Bizup, Lucinda Li, Malia Armstrong, Anushka Dalvi, Lina Nurhussien, Nora Horick, Chengbo Zeng, Nneka N. UfereBackground:
The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL).
Methods:
From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version).
Results:
Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%,
Conclusion:
These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.