Financial Toxicity and Its Determinants in Cardiovascular Diseases: A Systematic Review and Bayesian Meta-Analysis
Author(s)
Muhammed Shabil, M Pharm, Ganesh Bhushi, M Pharm, Eswaran Maheswari, PhD.
Department of Pharmacy Practice, MS Ramaiah University of Applied Sciences, Bangalore, India.
Department of Pharmacy Practice, MS 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 PubMed, Embase, Scopus, and Web of Science until May 2025 for full-text studies reporting financial toxicity in CVD patients. Eligible studies included observational and interventional designs measuring financial toxicity via catastrophic health expenditure (CHE), difficulty paying medical bills, or distress financing. Data on prevalence, determinants, and outcomes were extracted, with quality assessed using the JBI tool. Random-effects meta-analyses pooled prevalence estimates, and Bayesian hierarchical models with weakly informative priors estimated posterior probabilities. Analyses were conducted using R software (version 4.4). The study has been registered in PROSPERO: CRD420251080078
RESULTS: From 14,207 records, 30 full-text studies (n=1,087,594) across multiple countries were included. Pooled prevalence of 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 PubMed, Embase, Scopus, and Web of Science until May 2025 for full-text studies reporting financial toxicity in CVD patients. Eligible studies included observational and interventional designs measuring financial toxicity via catastrophic health expenditure (CHE), difficulty paying medical bills, or distress financing. Data on prevalence, determinants, and outcomes were extracted, with quality assessed using the JBI tool. Random-effects meta-analyses pooled prevalence estimates, and Bayesian hierarchical models with weakly informative priors estimated posterior probabilities. Analyses were conducted using R software (version 4.4). The study has been registered in PROSPERO: CRD420251080078
RESULTS: From 14,207 records, 30 full-text studies (n=1,087,594) across multiple countries were included. Pooled prevalence of 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
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PT40
Topic
Epidemiology & Public Health, Patient-Centered Research
Topic Subcategory
Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)