Out-of-pocket annual health expenditures and financial toxicity from healthcare costs in patients with heart failure in the United States

Stephen Y. Wang, Javier Valero-Elizondo, Hyeon Ju Ali, Ambarish Pandey, Miguel Cainzos-Achirica, Harlan M. Krumholz, Khurram Nasir, Rohan Khera

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


BACKGROUND: Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out-ofpocket healthcare costs on patients with HF and their families. METHODS AND RESULTS: In the Medical Expenditure Panel Survey, we identified all families with ≥1 adult member with HF during 2014 to 2018. Total out-of-pocket healthcare expenditures included yearly care-specific costs and insurance premiums. We evaluated 2 outcomes of financial toxicity: (1) high financial burden—total out-of-pocket healthcare expense to postsubsistence income ratio of >20%, and (2) catastrophic financial burden with the ratio of >40%—a bankrupting expense defined by the World Health Organization. There were 788 families in the Medical Expenditure Panel Survey with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out-of-pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%–18%) of families experienced a high burden and 5% (95% CI, 3%–6%) experienced a catastrophic burden. Among the two-fifths of families considered low income, 24% (95% CI, 18%–30%) experienced a high financial burden, whereas 10% (95% CI, 6%–14%) experienced a catastrophic burden. Low-income families had 4-fold greater risk-adjusted odds of high financial burden (odds ratio [OR], 3.9; 95% CI, 2.3–6.6), and 14-fold greater risk-adjusted odds of catastrophic financial burden (OR, 14.2; 95% CI, 5.1–39.5) compared with middle/high-income families. CONCLUSIONS: Patients with HF and their families experience large out-of-pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low-income families.

Original languageEnglish (US)
Article numbere022164
JournalJournal of the American Heart Association
Issue number14
StatePublished - Jul 10 2021


  • Costs of care
  • Financial hardship
  • Financial toxicity
  • Out-of-pocket

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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