Financial Toxicity in Chronic Obstructive Pulmonary Disease

/ABSTRACT Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease that affects more than 13 million Americans and results in a long period of disability and reduced health related quality of life (HRQoL). Individuals with COPD are at high risk of financial burden from illness due to costly inhaled bronchodilators, unplanned ED visits and hospitalizations for acute exacerbations, as well as income loss due to disability. Financial toxicity, a term that describes the objective financial burden and subjective financial distress resulting from treatment for illness, has not been studied in COPD but is prevalent in other chronic medical conditions and has been associated with worse health outcomes. In contrast to absolute cost, financial toxicity takes into account the proportion of cost to an individual’s or family’s income and its psychological and behavioral impact. While cost has not been directly associated with worse outcomes in COPD, limited observational studies relying on self-reported adherence suggest that cost of treatment may contribute to suboptimal medication adherence. Poor adherence, in turn, is associated with worse outcomes including increased risk of exacerbations and mortality. Due to the high risk for financial burden in COPD, understanding the association between financial toxicity, a potentially modifiable determinant, and health outcomes is key to informing future interventions. The main objective of this proposal is to describe the impact of financial toxicity on health outcomes in individuals with COPD. We hypothesize that financial toxicity from treatment of COPD is associated with increased disability, decreased health related quality of life (HRQoL), and decreased medication adherence over time. We will use both quantitative and qualitative methods to comprehensively evaluate the role of financial toxicity in individuals with COPD. Using the Medical Expenditure Panel Survey (MEPS), a large nationally-representative longitudinal panel, we will assess the association between material financial toxicity resulting from treatment of COPD with disability and health related quality of life (Specific Aim 1) and medication adherence (Specific Aim 2). To better understand the impact of financial toxicity on patient outcomes, we will conduct qualitative semi-structured interviews with individuals who report financial burden related to treatment for COPD (Specific Aim 3). Taken together, the work from these complementary aims has the potential to identify areas for a future intervention to mitigate the adverse effects of financial toxicity in this population, which would serve as the basis for the applicant’s future career development award. This proposal will also provide the applicant with the skills needed to pursue an independent career as a health services researcher studying COPD. Project Number: 5F32HL176086-02 | Fiscal Year: 2025 | NIH Institute/Center: National Heart Lung and Blood Institute (NHLBI) | Principal Investigator: Sonal Mallya | Institution: JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD | Award Amount: $101,360 | Activity Code: F32 | Study Section: Special Emphasis Panel[ZRG1-F18-E(20)L] View on NIH RePORTER: https://reporter.nih.gov/project-details/5F32HL17608602