Financial Toxicity Among Patients with Peripheral Artery Disease

Financial toxicity (FT) describes the objective and subjective financial hardships incurred by patients in paying for health care. While peripheral artery disease (PAD) is known to be associated with high total costs and out-of-pocket (OOP) spending, the impact of these costs on patients is poorly described. The objectives of this study were (1) to examine the rates of subjective and objective FT in patients with and without PAD, and (2) to describe other factors that may contribute to FT in this cohort.

Individuals older than 40 years were identified from the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey years 2017-2022. The cohort was stratified by a diagnosis of PAD and the primary outcomes were subjective and objective FT. Subjective FT was represented by a composite of survey questions covering delays in care due to cost and trouble paying medical bills. Objective FT was represented by catastrophic health spending, defined as OOP health-care costs >40% of postsubsistence income.

A weighted cohort of 140,271,167 individuals (851,446 with PAD) were included. PAD was associated with significantly greater odds of both subjective (30.2% vs. 23.4%, odds ratio [OR] [95% confidence interval {CI}] = 1.456 [1.130-1.876], P = 0.004) and objective (6.4% vs. 2.3%, OR [95% CI] = 2.128 [1.028-4.405], P = 0.042]) FT. In addition to PAD, cardiovascular disease, pulmonary disease, and diabetes were associated with significantly greater odds of both subjective (cardiovascular disease OR = 1.307, pulmonary disease OR = 1.438, diabetes OR = 1.359, all P < 0.001) and objective (cardiovascular disease OR = 1.260, pulmonary disease OR = 1.265, diabetes OR = 1.219, all P < 0.015) FT. Medicaid coverage (subjective OR [95% CI] = 0.588 [0.527-0.657], P < 0.001; objective OR [95% CI] = 0.306 [0.192-0.489], P < 0.001) and high income (subjective OR [95% CI] = 0.482 [0.434-0.537], P < 0.001; objective OR [95% CI] = 0.180 [0.103-0.314], P < 0.001) were both protective against subjective and objective FT. While never marrying was protective against subjective FT (OR [95% CI] = 0.890 [0.814-0.973], P = 0.010), it was associated with significantly greater odds of objective FT (OR [95% CI] = 1.372 [1.118-1.684], P = 0.003).

PAD is associated with significantly greater odds of subjective and objective FT. An understanding of FT and its impact on patients is essential for vascular surgeons to provide comprehensive care for these patients.