Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
College of Medicine, University of Central Florida, Orlando, FL.
Urology. 2023 Apr;174:52-57. doi: 10.1016/j.urology.2023.01.010. Epub 2023 Jan 26.
To characterize stone-related financial burden among adults with nephrolithiasis through validated questionnaires for financial toxicity.
We performed a cross-sectional survey of adults with history of nephrolithiasis at an outpatient clinic. The survey contained a measure of stone-related financial toxicity (COST score), and assessed demographics, stone event history, and burden of overall, ancillary, preventative, and insurance costs. A COST score ≤21 was classified as high financial toxicity. Multivariable logistic regression was used to evaluate associations with demographic variables and stone event history.
One hundred patients completed the survey (median age 57, IQR, 48-64). The median COST score was 30 (IQR, 23-37), and 19% reported high financial toxicity. Insurance status, household income, stone surgeries during lifetime and within the last 3 years were associated with financial toxicity on univariable analysis (P <.05). Burden of costs was significantly higher in all categories within the high financial toxicity cohort (each P <.05). On multivariable logistic regression, only income >$75,000 remained significant within the second model (OR: 0.22, 95% CI, 0.05-0.77, P = .02), however, this relationship did not persist on the final model. When asked whether providers should be mindful of their financial situation prior to making treatment recommendations, 39% responded "quite a bit" or "very much."
One in 5 patients seeking care for nephrolithiasis meet criteria for high financial toxicity. Financial toxicity was associated with household income, insurance, education, and frequency of stone events. Thirty-nine percent reported that their provider should be mindful of their financial situation when making recommendations.
通过验证过的财务毒性问卷，对肾结石患者的结石相关经济负担进行特征描述。
我们对门诊就诊的肾结石患者进行了横断面调查。该调查包含结石相关财务毒性（COST 评分）量表，并评估了人口统计学特征、结石病史以及总费用、辅助治疗费用、预防费用和保险费用负担。COST 评分≤21 被归类为高财务毒性。多变量逻辑回归用于评估与人口统计学变量和结石事件史的相关性。
100 名患者完成了调查（中位数年龄 57 岁，四分位距 48-64 岁）。COST 评分中位数为 30 分（四分位距 23-37 分），19%的患者报告存在高财务毒性。在单变量分析中，保险状况、家庭收入、一生中以及过去 3 年内的结石手术与财务毒性相关（P<.05）。在高财务毒性组中，所有类别的费用负担均显著更高（均 P<.05）。在多变量逻辑回归中，仅收入>75000 美元在第二个模型中仍然具有显著性（OR：0.22，95%CI：0.05-0.77，P=0.02），然而，这种关系在最终模型中并不存在。当被问及提供者在提出治疗建议之前是否应该考虑患者的经济状况时，39%的人回答“相当多”或“非常多”。
在寻求肾结石治疗的患者中，每 5 人中就有 1 人符合高财务毒性标准。财务毒性与家庭收入、保险、教育程度和结石事件频率有关。39%的患者报告称，他们的提供者在提出建议时应考虑他们的财务状况。
