Financial burden among liver transplant candidates is associated with financial distress and work impairment: A U.S. multicenter study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL). METHODS: From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version). RESULTS: Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%, p=0.018) among employed participants. In adjusted models, high financial burden was significantly associated with inability to pay for basic necessities (aOR 4.76, 95% CI: 2.34-9.67), delayed or foregone medical care (aOR 4.02, 95% CI: 2.30-7.02), and psychological distress (aOR 4.63, 95% CI: 1.95-10.98) but was not associated with HRQOL (EQ-5D β: -0.04, 95% CI: -0.08 to 0.00; EQ-5D-VAS β: -4.53, 95% CI: -10.1 to 1.02). CONCLUSION: These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.
Source: Hepatology Communications
Authors: Elizabeth S. Aby, Melanie Hundt, Jonathan Rice, Mike Kriss, Kali Zhou, Lauren Nephew, Sarah R. Lieber, Alvaro Noriega Ramirez, Brett E. Fortune, Clara Tow, Paola Mejia, Deepika Devuni, Anita Krisharao, Shari Rogal, Alan Noll, Stela Celaj, Nathaly Cortez Bazan, Patricia Jones, Hersh Shroff, Krista Hunt, Areej Mazhar, Dempsey Hughes, Jackie B. Henson, Lindsay Y. King, Thomas M. Leventhal, Enya Zhu, Grace Bizup, Lucinda Li, Malia Armstrong, Anushka Dalvi, Lina Nurhussien, Nora Horick, Chengbo Zeng, Nneka N. Ufere
Institutions: University of Minnesota, University of Southern California, University of Colorado Anschutz, University of Colorado Denver, Indiana University Indianapolis, The University of Texas Southwestern Medical Center, Albert Einstein College of Medicine, University of Massachusetts Chan Medical School, University of Pittsburgh, University of Pittsburgh Medical Center, University of Miami, Jackson Memorial Hospital, University of Miami Health System, University of North Carolina at Chapel Hill, Northwestern University, Duke University, Duke Medical Center, Duke University Health System, Massachusetts General Hospital, Brigham and Women's Hospital
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,700
OpenAlex ID: W7166583766