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Financial Toxicity and Its Determinants in Cardiovascular Diseases: A Systematic Review and Bayesian Meta-Analysis.
Muhammed Shabil1, Eswaran Maheswari1, Amogh Verma2,3,4
1Department of Pharmacy Practice, Faculty of Pharmacy, MS Ramaiah University of Applied Sciences, Bangalore, India.
Summary
Financial toxicity significantly impacts cardiovascular disease patients, with high rates of medical expense burden and difficulty paying bills. Addressing socioeconomic factors and healthcare system structures is crucial for equitable care.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Public Health
Background:
- Financial toxicity, encompassing economic hardship from healthcare costs, is a critical but under-synthesized aspect of cardiovascular disease.
- It includes out-of-pocket expenses, indirect costs, medical debt, and access barriers.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence and determinants of financial toxicity in patients with cardiovascular diseases.
- To synthesize current evidence on the economic burden associated with cardiovascular care.
Main Methods:
- A systematic review and Bayesian meta-analysis were performed, searching major databases up to May 2025.
- Included 30 studies with over 1 million patients, analyzing pooled prevalence and heterogeneity using random-effects and Bayesian models.
Main Results:
- Catastrophic health expenditure (>40% of out-of-pocket spending) affected 28-34% of patients; 46% struggled to pay medical bills.
- Significant heterogeneity was observed, influenced by healthcare systems, disease severity, and socioeconomic factors.
- Key determinants included lack of insurance, low income, rural residence, younger age, and intensive treatments.
Conclusions:
- Financial toxicity is highly prevalent in cardiovascular disease patients, driven by socioeconomic vulnerability and healthcare system design.
- Strategies like financial risk screening, enhanced insurance, reduced out-of-pocket costs, and targeted support are vital for equitable cardiovascular care.
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