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Master of Public Health

Financial burden following adult liver transplantation is common and associated with adverse recipient outcomes

AUTHORS

Ufere NN , Serper M , Kaplan A , Horick N , Indriolo T , Li L , Satapathy N , Donlan J , Castano Jimenez JC , Lago-Hernandez C , Lieber S , Gonzalez C , Keegan E , Schoener K , Bethea E , Dageforde LA , Yeh H , El-Jawahri A , Park ER , Vodkin I , Schonfeld E , Nipp R , Desai A , Lai JC , . Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2024 2 15; ().

ABSTRACT

BACKGROUND & AIMS: The financial impact of liver transplantation has been underexplored. We aimed to identify associations between high financial burden (≥ 10% annual income spent on out-of-pocket [OOP] medical costs) and work productivity, financial distress (coping behaviors in response to financial burden), and financial toxicity (health-related quality of life, HRQOL) among adult liver transplant recipients.

APPROACH & RESULTS: Between 6/2021-5/2022, we surveyed 207 adult liver transplant recipients across five U.S. transplant centers. Financial burden and distress were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed the Work Productivity and Activity Impairment and EQ-5D-5L HRQOL questionnaires. In total, 23% of recipients reported high financial burden which was significantly associated with higher daily activity impairment (32.9% vs. 23.3%, p=0.048). In adjusted analyses, high financial burden was significantly and independently associated with delayed or foregone medical care (aOR, 3.95; 95% CI 1.85-8.42) and being unable to afford basic necessities (aOR, 5.12; 95% CI 1.61-16.37). Recipients experiencing high financial burden had significantly lower self-reported HRQOL as measured by the EQ-5D-5L compared to recipients with low financial burden (67.8 vs. 76.1, p=0.008) and an age- and sex-matched U.S. general population (67.8 vs. 79.1, p<0.001).

CONCLUSIONS: In this multicenter cohort study, nearly 1 in 4 adult liver transplant recipients experienced high financial burden, which was significantly associated with delayed or foregone medical care and lower self-reported HRQOL. These findings underscore the need to evaluate and address financial burden in this population before and after transplantation.

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