title: Financial burden in recipients of allogeneic hematopoietic cell transplantation.
abstract: Although allogeneic hematopoietic cell transplantation (HCT) is an expensive treatment for hematological disorders, little is known about the financial consequences for the patients who undergo this procedure. We analyzed factors associated with its financial burden and its impact on health behaviors of allogeneic HCT recipients. A questionnaire was retrospectively mailed to 482 patients who underwent allogeneic HCT from January 2006 to June 2012 at the Mayo Clinic, to collect information regarding current financial concerns, household income, employment, insurance, out-of-pocket expenses, and health and functional status. A multivariable logistic regression analysis identified factors associated with financial burden and treatment nonadherence. Of the 268 respondents (56% response rate), 73% reported that their sickness had hurt them financially. All patients for whom the insurance information was available (missing, n = 13) were insured. Forty-seven percent of respondents experienced financial burden, such as household income decreased by >50%, selling/mortgaging home, or withdrawing money from retirement accounts. Three percent declared bankruptcy. Younger age and poor current mental and physical functioning increased the likelihood of financial burden. Thirty-five percent of patients reported deleterious health behaviors because of financial constraints. These patients were likely to be younger, have lower education, and with a longer time since HCT. Being employed decreased the likelihood of experiencing financial burden and treatment nonadherence due to concern about costs. A significant proportion of allogeneic HCT survivors experience financial hardship despite insurance coverage. Future research should investigate potential interventions to help at-risk patients and prevent adverse financial outcomes after this life-saving procedure.
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona. Electronic address: khera.nandita@mayo.edu.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Yu-hui
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shahrukh
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: James
authors.initials: J
authors.lastname: Slack
authors.affiliation: Health Sciences Research Division, Mayo Clinic, Rochester, Minnesota.
authors.forename: Timothy
authors.initials: T
authors.lastname: Beebe
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Pierre
authors.initials: P
authors.lastname: Noel
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Veena
authors.initials: V
authors.lastname: Fauble
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Lisa
authors.initials: L
authors.lastname: Sproat
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jon
authors.initials: J
authors.lastname: Tilburt
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Leis
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mikhael
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D019172:Transplantation Conditioning / Q000191:economics*; D014184:Transplantation, Homologous / Q000191:economics*; D055815:Young Adult
keywords: Allogeneic hematopoietic cell transplantation; Economics; Financial burden; Quality of life