Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL.
J Clin Oncol. 2023 Feb 10;41(5):1011-1022. doi: 10.1200/JCO.22.00461. Epub 2022 Dec 1.
The financial burden experienced by blood or marrow transplant (BMT) survivors during the COVID-19 pandemic remains unstudied. We evaluated the risk for high out-of-pocket medical costs and associated financial burden experienced by BMT survivors and a sibling comparison group during the COVID-19 pandemic.
This study included 2,370 BMT survivors and 750 siblings who completed the BMT Survivor Study survey during the pandemic. Participants reported employment status, out-of-pocket medical costs, and financial burden. Medical expenses ≥ 10% of the annual household income constituted high out-of-pocket medical costs. Logistic regression identified factors associated with high out-of-pocket medical costs and financial burden.
BMT survivors were more likely to incur high out-of-pocket medical costs (11.3% 3.1%; adjusted odds ratio [aOR], 2.88; 95% CI, 1.84 to 4.50) than the siblings. Survivor characteristics associated with high out-of-pocket medical costs included younger age at study (aOR, 1.02; 95% CI, 1.00 to 1.03), lower prepandemic annual household income and/or education (< $50,000 US dollars and/or < college graduate: aOR, 1.96; 95% CI, 1.42 to 2.69; reference: ≥ $50,000 in US dollars and ≥ college graduate), > 1 chronic health condition (aOR, 2.82; 95% CI, 2.00 to 3.98), ≥ 1 hospitalization during the pandemic (aOR, 2.11; 95% CI, 1.53 to 2.89), and being unemployed during the pandemic (aOR, 1.52; 95% CI, 1.06 to 2.17). Among BMT survivors, high out-of-pocket medical costs were significantly associated with problems in paying medical bills (aOR, 10.57; 95% CI, 7.39 to 15.11), deferring medical care (aOR, 4.93; 95% CI, 3.71 to 6.55), taking a smaller dose of medication than prescribed (aOR, 4.99; 95% CI, 3.23 to 7.70), and considering filing for bankruptcy (aOR, 3.80; 95% CI, 2.14 to 6.73).
BMT survivors report high out-of-pocket medical costs, which jeopardizes their health care and may affect health outcomes. Policies aimed at reducing financial burden in BMT survivors, such as expanding access to patient assistance programs, may mitigate the negative health consequences.
血液或骨髓移植（BMT）幸存者在 COVID-19 大流行期间所经历的经济负担仍未得到研究。我们评估了 COVID-19 大流行期间 BMT 幸存者和兄弟姐妹对照组发生高额自付医疗费用的风险及其相关的经济负担。
本研究纳入了 2370 名 BMT 幸存者和 750 名兄弟姐妹，他们在大流行期间完成了 BMT 幸存者研究调查。参与者报告了就业状况、自付医疗费用和经济负担。医疗费用占家庭年收入的 10%以上被认为是高额自付医疗费用。Logistic 回归分析确定了与高额自付医疗费用和经济负担相关的因素。
与兄弟姐妹相比，BMT 幸存者更有可能产生高额自付医疗费用（11.3% vs. 3.1%；调整后的优势比[aOR]，2.88；95%置信区间[CI]，1.84 至 4.50）。与高额自付医疗费用相关的幸存者特征包括研究时年龄较小（aOR，1.02；95%CI，1.00 至 1.03）、大流行前家庭年收入和/或教育程度较低（<50000 美元和/或未完成大学学业：aOR，1.96；95%CI，1.42 至 2.69；参考值：≥50000 美元和/或完成大学学业）、≥1 种慢性健康状况（aOR，2.82；95%CI，2.00 至 3.98）、≥1 次大流行期间住院治疗（aOR，2.11；95%CI，1.53 至 2.89）和大流行期间失业（aOR，1.52；95%CI，1.06 至 2.17）。在 BMT 幸存者中，高额自付医疗费用与支付医疗费用困难（aOR，10.57；95%CI，7.39 至 15.11）、推迟医疗（aOR，4.93；95%CI，3.71 至 6.55）、服用低于规定剂量的药物（aOR，4.99；95%CI，3.23 至 7.70）和考虑申请破产（aOR，3.80；95%CI，2.14 至 6.73）显著相关。
BMT 幸存者报告了高额自付医疗费用，这危及了他们的医疗保健，并可能影响健康结果。旨在减轻 BMT 幸存者经济负担的政策，例如扩大患者援助计划的获取途径，可能会减轻这些负面健康后果。
