Presentation (CTI)

OBJECTIVES: Medication prices and healthcare expenses in the US are very high compared to other developed countries in the world resulting in potential unaffordability, compromised health outcomes, and negative downstream financial burden among adult patients, especially among the elderly. We conducted a systematic literature review to synthesize data on the financial burden, toxicity, outcomes, interventions, and potential impact of policy changes on out-of-pocket medication and healthcare expenses among adult/elderly patients in the US.
METHODS: A systematic review of peer-reviewed articles identified through electronic and manual searches in the literature (PubMed and Google) over the last 10 years (2015-current) was conducted. Search terms included “medication out-of-pocket costs”, “financial toxicity”, “older patients”, and “United States”. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed.
RESULTS: The initial search resulted in 440 articles, of which 112 articles were included in this review. The review articles were categorized into 4 sub-themes [out-of-pocket costs and outcomes (n=54); policy changes and impact (n=22); financial toxicity (n=19); and measures/interventions to alleviate financial burden on patients (n=17). The financial burden (cost-sharing) among adult/elderly patients due to rising medication and healthcare expenses is high (n=28) resulting in poor outcomes including lower medication utilization/adherence (n=22), quality of life, outcomes, and increased spending on healthcare resources (n=9), and worsening financial toxicity (n=19). Recent government and local policies including the Affordable Care Act and the Inflation Reduction Act may help in limiting out-of-pocket expenses among adult/elderly patients (n=22). Potential interventions/measures to mitigate the financial burden on patients included financial screening, counseling, financial assistance, and referrals (n=17).
CONCLUSIONS: This systematic literature review was the first to synthesize and consolidate recent publications providing a broad review on cost-sharing policies, increased financial burden to patients, negative impact on adherence and outcomes, and the need for more policies and measures to improve the financial hardship to patients.