HIGH FINANCIAL BURDEN IS COMMON AMONG ADULTS UNDERGOING LIVER TRANSPLANT (LT) EVALUATION AND IS ASSOCIATED WITH FINANCIAL, HOUSING AND TRANSPORTATION INSECURITY: THE U.S. MULTICENTER PACE-LT STUDY

Background: The financial impact of chronic liver disease (CLD) care has been underexplored. We aimed to evaluate the association of high financial burden (>/= 10% annual income spent on out-of-pocket [OOP] medical costs) with the presence of social risk factors (healthcare-related financial, housing, transportation, and food insecurity) in adults undergoing liver transplant (LT) evaluation.

Methods: We conducted a multicenter prospective study of adult patients undergoing LT evaluation between 5/2023-10/2023 across 11 U.S. transplant centers. Financial burden and healthcare-related financial insecurity (e.g., delayed or forgone medical care, medical debt/bankruptcy, loss of savings or assets and/or being unable to pay for basic necessities due to OOP costs) were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed a 6-item survey assessing the presence of housing, transportation, and food insecurity modified from the Health Leads Social Needs Screening Toolkit. Logistic regressions were conducted to evaluate associations between participant characteristics, financial burden, and social risk factors.

Results: 306 adults undergoing LT evaluation were enrolled. Median age was 59 with a median MELD-Na of 16; most had alcohol-related liver disease (49%) (Table). The majority were male (58%) and White (82%) with 26% being Hispanic. Overall, 46% had an annual household income of under $50,000, 35% had public insurance, and 28% were employed.

In total, 26% of LT candidates reported high financial burden; this was not significantly associated with any sociodemographic or clinical factors.

LT candidates who reported high financial burden were significantly more likely to experience healthcare-related financial insecurity (Figure). After controlling for household income, employment status, marital status, insurance type, and center, high financial burden was significantly associated with delayed or foregone medical care (aOR, 4.8; 95% CI 2.6-9.1), loss of savings/assets (aOR, 6.4; 95% CI 3.4-12.6), medical debt/bankruptcy (aOR, 3.9; 95%CI 2.0-7.6), and inability to pay for basic necessities (aOR, 4.5; 95% CI 2.1-10.0). LT candidates reporting high financial burden were also significantly more likely to report housing insecurity (36% vs. 20%, p=0.006) and transportation insecurity (18% vs. 9%, p=0.04), but not food insecurity (24% vs. 14%, p=0.06).

Conclusions: In this multicenter cohort of adults undergoing LT evaluation, over 1 in 4 reported high financial burden. High financial burden was significantly associated with experiencing healthcare-related financial insecurity, housing insecurity, and transportation insecurity. These findings underscore the pressing need for a holistic care approach for patients with CLD that addresses the intricate interplay between health, financial, and social risk factors.