B16-04 Financial Toxicity From COPD-related Costs in the Medical Expenditure Panel Survey (MEPS)

Rationale Individuals with chronic obstructive pulmonary disease (COPD) are at high risk for financial burden due to unplanned emergency department visits and hospitalizations for acute exacerbations, income loss due to disability, and high out-of-pocket costs for inhaled bronchodilators. Financial toxicity, defined as medical expenses exceeding 20% of a family’s post-subsistence income, may impact health outcomes, but it has not been studied in COPD. We aimed to evaluate the relationship between financial toxicity and health-related quality of life and disability. Methods We identified adults living with COPD using ICD-10-CM codes in years 2017-2023 of the Medical Expenditure Panel Survey (MEPS), a nationally-representative longitudinal survey. Annual out-of-pocket and total expenses for COPD were calculated as a sum of expenses associated with a diagnostic code for COPD across 8 service categories. Financial toxicity was defined as total medical expenses associated with COPD exceeding 20% of the individual’s annualized family post-subsistence income. Multivariable mixed models were used to examine the relationship between financial toxicity and health-related quality of life and presence of physical disability. All models included random intercepts to account for within-person correlation across repeated measures and were adjusted for age, sex, race/ethnicity, educational attainment, insurance status, number of comorbidities, and time. Results A total of 2381 unique adults with COPD were identified from the MEPS years 2017-2023, of whom 629 (26%) met criteria for financial toxicity at their first time point. Baseline characteristics are summarized in Table 1. A greater proportion of individuals with financial toxicity identified as non-Hispanic Black, had lower educational attainment, and were covered by Medicaid. After adjusting for covariates, financial toxicity was associated with lower Veterans RAND 12-item Health Survey (VR-12) Physical Component Score (β, -2.04; 95% CI, -2.88 to -1.20) and VR-12 Mental Component Score (β, -0.90; 95% CI, -1.75 to -0.06), corresponding to worse health-related quality of life, and presence of physical disability (aOR, 1.74; 95% CI 1.25 to 2.41). Conclusion In this analysis of the MEPS years 2017-2023, 26% of individuals with COPD experienced financial toxicity. Financial toxicity was associated with worse health-related quality of life and increased presence of physical disability. These findings underscore the need for targeted interventions to identify and reduce financial toxicity among individuals with COPD as well as policy initiatives to protect patients from high medical costs, as financial toxicity may negatively impact patient-reported outcomes. This abstract is funded by: NHLBI F32HL176086