Financial toxicity negatively impacts outcomes in lower extremity trauma patients

Abstract

Background: Financial toxicity describes the adverse economic effects of injury, including both direct costs, such as the price of medical care, and indirect costs, such as lost wages. Financial toxicity is associated with worse health-related quality of life, as well as worse psychological and clinical outcomes. We aimed to characterize financial toxicity in an international cohort of lower extremity trauma patients.

Methods: We conducted a cross-sectional survey of patients with a history of traumatic lower extremity injury distal to the mid-femur. We collected demographic, clinical, and patient-reported outcomes (PROs) data using the LIMB-Q. Our primary outcome was the LIMB-Q Financial Burden score (range 0-100, lower scores indicate greater financial toxicity).

Results: We collected data from 301 respondents. Mean age was 42 years (SD 16). Most respondents were men (64%), White (65%), and American (71%) with less than a college degree (56%) and annual incomes of less than $30,000 (29%). The median time from injury was 2 years (IQR: 1-4). Most respondents underwent fracture fixation only (56%), followed by soft tissue reconstruction (28%), and amputation (16%). The mean LIMB-Q Financial Burden score was 56 (SD 20). Amputation was associated with the greatest financial toxicity (p<0.05). Black race, lower education level, and lower income were associated with greater financial toxicity (p<0.05). Greater financial toxicity was associated with worse scores on LIMB-Q Symptoms and Psychological scales (p<0.01). Financial toxicity did not change with increasing time from injury (p>0.05).

Conclusion: Risk factors for financial toxicity among lower extremity trauma patients included amputation, soft tissue reconstruction, Black race, lower education level, and lower income. Financial toxicity may be a modifiable risk factor for improving clinical outcomes in high-risk patients.

Keywords: Amputation; Financial toxicity; Lower extremity; Quality of life; Reconstruction; Trauma.