Liver Center, Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA.
Emory UniversityAtlantaGeorgiaUSA.
Liver Transpl. 2022 Dec;28(12):1920-1935. doi: 10.1002/lt.26514. Epub 2022 Jul 7.
The economic burden of chronic liver disease is rising; however, the financial impact of chronic liver disease on patients and families has been underexplored. We performed a scoping review to identify studies examining financial burden (patient/family health care expenditures), financial distress (material, behavioral, and psychological consequences of financial burden), and financial toxicity (adverse health outcomes of financial distress) experienced by patients with chronic liver disease and their families. We searched MEDLINE, Embase, Cochrane Library, and the Web of Science online databases for articles published since the introduction of the Model for End-Stage Liver Disease score for liver transplantation allocation in February 2002 until July 2021. Final searches were conducted between June and July 2021. Studies were included if they examined the prevalence or impact of financial burden or distress among patients with chronic liver disease and/or their caregivers. A total of 19 observational studies met inclusion criteria involving 24,549 patients and 276 caregivers across 5 countries. High rates of financial burden and distress were reported within the study populations, particularly among patients with hepatic encephalopathy, hepatocellular carcinoma, and liver transplantation recipients. Financial burden and distress were associated with increased pre- and posttransplantation health care utilization and poor health-related quality of life as well as caregiver burden, depression, and anxiety. None of the included studies evaluated interventions to alleviate financial burden and distress. Observational evidence supports the finding that financial burden and distress are underrecognized but highly prevalent among patients with chronic liver disease and their caregivers and are associated with poor health outcomes. There is a critical need for interventions to mitigate financial burden and distress and reduce financial toxicity in chronic liver disease care.
慢性肝脏疾病的经济负担正在增加；然而，慢性肝脏疾病对患者及其家庭的经济影响尚未得到充分探讨。我们进行了范围界定审查，以确定研究慢性肝脏疾病患者及其家庭所经历的经济负担（患者/家庭医疗保健支出）、经济困境（经济负担的物质、行为和心理后果）和经济毒性（经济困境的不良健康后果）的研究。我们在 2002 年 2 月引入终末期肝病模型用于肝移植分配后，在 MEDLINE、Embase、Cochrane 图书馆和 Web of Science 在线数据库中搜索了截至 2021 年 7 月发表的文章。最后一次搜索是在 2021 年 6 月至 7 月之间进行的。如果研究考察了慢性肝脏疾病患者及其护理人员的经济负担或困境的流行率或影响，则将其纳入研究。共有 19 项观察性研究符合纳入标准，涉及 5 个国家的 24549 名患者和 276 名护理人员。研究人群中报告了很高的经济负担和困境发生率，特别是在肝性脑病、肝细胞癌和肝移植受者中。经济负担和困境与术前和术后医疗保健利用增加以及健康相关生活质量差以及护理人员负担、抑郁和焦虑有关。纳入的研究均未评估减轻经济负担和困境的干预措施。观察性证据支持以下发现，即慢性肝脏疾病患者及其护理人员普遍存在但认识不足的经济负担和困境与不良健康结局有关。减轻慢性肝脏疾病护理中的经济负担和困境并减少经济毒性的干预措施非常迫切。
