Out-of-pocket health care spending among patients with acute limb ischemia stratified by income.

Abstract

Acute limb ischemia (ALI) results in high health care costs due to the near-universal need for surgical procedures and long hospital stays. Beyond the system costs incurred due to ALI, out-of-pocket (OOP) costs have a significant impact on patients' well-being and compliance with care. The objective of this study was to quantify OOP costs among individuals with ALI compared with the general population. This was a cross-sectional study of individuals aged 18 years or older in the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS) from 2017 to 2021. The primary exposure was ALI, which was determined by MEPS clinical classification codes. The cohort of patients with ALI was compared against a population without pre-determined common and significant chronic comorbidities. The primary endpoints for comparison were adjusted OOP spending and rates of catastrophic health spending (CHS). Analyses were also conducted with the cohort stratified by income quartile. A total of 2,172,062 weighted individuals with ALI were compared with 148,665,584 weighted individuals in the general population free of significant chronic disease. Individuals with ALI had significantly higher average annual OOP healthcare spending than the general population ($1992 vs $1013; β = 554.85; P = .001), which was driven by higher spending on inpatient hospitalizations ($140 vs $47; P < .001), prescription medications ($520 vs $158; P < .001), and other non-specified costs ($229 vs $48; P < .001). When stratifying by income quartile (low, lower-middle, upper-middle, and high income), the lower-middle income quartile (near-poor) had a CHS rate of 5.4%, compared with 0.1% to 1.1% in all other quartiles. Individuals with ALI had significantly higher rates of CHS in the lower-middle (13.9% vs 5.3%; P < .001) and upper-middle (3.1% vs 0.6%; P < .001) income quartiles, but not in the low (1.3% vs 1.0%; P = .719) or high (0.0% vs 0.1%; P = .695) income quartiles. Individuals with ALI and near-poor individuals are especially vulnerable to high OOP health care spending. Efforts aimed at reducing hospital length of stay and reducing medication costs could reduce OOP spending among patients with ALI. Further, policy reform to expand insurance coverage among the near-poor group or implementation of means-based OOP spending limits could significantly mitigate the vulnerability of this group.