FINANCIAL TOXICITY AND ITS DETERMINANTS IN CARDIOVASCULAR DISEASES: A SYSTEMATIC REVIEW AND BAYESIAN META-ANALYSIS...
Author(s)
Muhammed Shabil, M Pharm1, Maheswari Eswar, PhD, MPH2.
1PhD Student, M S Ramaiah University Of Applied Sciences, Bangalore, India, 2MS Ramaiah University of Applied Sciences, Bangalore, India.
1PhD Student, M S Ramaiah University Of Applied Sciences, Bangalore, India, 2MS Ramaiah University of Applied Sciences, Bangalore, India.
OBJECTIVES: Cardiovascular diseases (CVDs) are the leading global cause of mortality, imposing significant economic burdens on patients through financial toxicity, defined as economic hardship from direct and indirect medical costs. This systematic review and meta-analysis aimed to assess the prevalence and determinants of financial toxicity in CVD patients to inform targeted interventions and health policy reforms.
METHODS: We searched databases until May 2025 for full-text studies reporting financial toxicity in CVD patients. Eligible studies included observational and interventional designs measuring financial toxicity. Data on prevalence, determinants, and outcomes were extracted, with quality assessed using the Joanna Briggs Institute (JBI) tool. Random-effects meta-analyses pooled prevalence estimates using Bayesian hierarchical models.
RESULTS: From 14,207 records, 30 full-text studies (n=1,087,594) across multiple countries were included. Pooled prevalence of Catastrophic health expenditure (CHE) (>40% out-of-pocket [OOP]) was 28% (95% CI: 12-48%, Bayesian: 34%, 95% CrI: 16-53%). CHE (>20% OOP) prevalence was 15% (95% CI: 6-28%, Bayesian: 15%, 95% CrI: 1-21%). Difficulty paying medical bills affected 46% (95% CI: 34-58%, I²=99.8%; Bayesian: 46%, 95% CrI: 31-59%), and inability to pay impacted 16% (95% CI: 12-21%, I²=99.4%; Bayesian: 17%, 95% CrI: 11-22%). Key determinants included lack of insurance (OR: 1.17-11.37), low income (OR: 6.59-58.6), rural residence (OR: 1.93-5.13), and younger age (OR: 1.66-3.11).
CONCLUSIONS: Financial toxicity is highly prevalent among CVD patients, driven by socioeconomic and healthcare system factors. Interventions enhancing insurance coverage, reducing cost-sharing, and supporting low-income populations are critical to alleviate its impact.
METHODS: We searched databases until May 2025 for full-text studies reporting financial toxicity in CVD patients. Eligible studies included observational and interventional designs measuring financial toxicity. Data on prevalence, determinants, and outcomes were extracted, with quality assessed using the Joanna Briggs Institute (JBI) tool. Random-effects meta-analyses pooled prevalence estimates using Bayesian hierarchical models.
RESULTS: From 14,207 records, 30 full-text studies (n=1,087,594) across multiple countries were included. Pooled prevalence of Catastrophic health expenditure (CHE) (>40% out-of-pocket [OOP]) was 28% (95% CI: 12-48%, Bayesian: 34%, 95% CrI: 16-53%). CHE (>20% OOP) prevalence was 15% (95% CI: 6-28%, Bayesian: 15%, 95% CrI: 1-21%). Difficulty paying medical bills affected 46% (95% CI: 34-58%, I²=99.8%; Bayesian: 46%, 95% CrI: 31-59%), and inability to pay impacted 16% (95% CI: 12-21%, I²=99.4%; Bayesian: 17%, 95% CrI: 11-22%). Key determinants included lack of insurance (OR: 1.17-11.37), low income (OR: 6.59-58.6), rural residence (OR: 1.93-5.13), and younger age (OR: 1.66-3.11).
CONCLUSIONS: Financial toxicity is highly prevalent among CVD patients, driven by socioeconomic and healthcare system factors. Interventions enhancing insurance coverage, reducing cost-sharing, and supporting low-income populations are critical to alleviate its impact.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EPH2
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)