Financial hardship and cost-related nonadherence to medication in patients with liver disease in the United States

Aliment Pharmacol Ther. 2024 Aug;60(4):492-502. doi: 10.1111/apt.18122. Epub 2024 Jun 12.

Abstract

Background: Economic hardship associated with chronic liver disease (CLD) may delay timely access to healthcare.

Aim: To estimate the national burden of financial hardship across the spectrum of CLD in the United States (US) during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: A cross-sectional analysis was performed using the 2020-2021 US National Health Interview Survey database. The questionnaire defined financial hardship from medical bills and cost-related nonadherence to medications in patients with CLD. We used weighted survey analysis to obtain the national estimates.

Results: While 6.9% (95% confidence interval [CI]: 6.7%-7.2%) out of 60,689 US adults (weighted sample: 251 million) reported financial hardship and inability to pay medical bills; 10.6% (95% CI: 8.3%-13.4%), 18.2% (95% CI: 14.5%-22.6%), 22.6% (95% CI: 11.0%-41.0%) with hepatitis, CLD/cirrhosis, and liver cancer experienced an inability to pay their medical bills due to financial hardship, respectively. 19.8% (95% CI: 15.9%-24.5%) and 23.3% (95% CI: 12.5%-39.3%) with CLD/cirrhosis and liver cancer, respectively experienced cost-related nonadherence to medications, compared to a tenth of US adults (10.7%, 95% CI: 10.3%-11.2%). CLD/cirrhosis demonstrated an independent association with financial hardship from medical bills and cost-related nonadherence to medications. Overall, these disparities were more pronounced in individuals aged <65 years old. In addition, over 40% of individuals with CLD/cirrhosis reported difficulties accessing medical care during the COVID-19 pandemic. CLD/cirrhosis showed an independent association with difficulties accessing medical care due to COVID-19.

Conclusions: Financial hardship from medical bills and cost-related nonadherence to medication can negatively impact individuals with CLD and need further evaluation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Assessment of Medication Adherence*
  • COVID-19* / economics
  • COVID-19* / epidemiology
  • Chronic Disease / drug therapy
  • Cost of Illness
  • Cross-Sectional Studies
  • Female
  • Financial Stress*
  • Health Expenditures / statistics & numerical data
  • Health Services Accessibility / economics
  • Humans
  • Liver Diseases* / drug therapy
  • Liver Diseases* / economics
  • Male
  • Middle Aged
  • SARS-CoV-2
  • United States
  • Young Adult