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Financial Toxicity Associated With Finger Amputation: A National Comparison Of Replantation And Revision Amputation
Jessica I. Billig, MD, MSc1, Neil Kamdar, MA2, Erika D. Sears, MD, MSc3;
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2University of Michigan, Ann Arbor, MI, USA, 3Univers, Ann Arbor, MI, USA

PURPOSE: Unplanned injuries, such as finger amputation, can result in substantial financial burden for patients, defined as financial toxicity. Yet, the degree of direct medical costs borne by the patient after upper extremity trauma is unknown.
METHODS: We conducted a retrospective population-based cohort study of patients suffering traumatic finger amputation (2009-2018). We divided our cohort into patients who initially underwent revision amputation or replantation. Cumulative healthcare utilization and out-of-pocket (OOP) expenses were obtained for the one-year post-injury period. We performed generalized linear models to examine the association between patient/clinical characteristics and OOP expenses.
RESULTS: A total of 10,784 (98.2%) initially underwent revision amputation and 191 (1.7%) underwent replantation. Patients who initially underwent revision amputation had significantly fewer hand therapy visits (39.7% vs. 58.1%, p-value:<0.001) and re-operations (36.8% vs. 57.6%, p-value:<0.001). This translated to significant differences in adjusted OOP expenses for the one-year post-injury period, with the highest OOP expenses among patients with private insurance who underwent replantation. The associated adjusted OOP expenses for replantation were $910 (95%CI: $787-$1,050) for patients with private insurance and $267 (95%CI: $163-$436) for patients with Medicare. Whereas patients receiving revision amputation with private insurance had adjusted OOP payments of $613 (95%CI: $595-$632) versus $311 (95%CI: $292-$331) for patients with Medicare.
CONCLUSION: OOP expenses after traumatic finger amputation vary significantly based on insurance status and treatment. Patients with private health insurance are at the highest risk of financial toxicity, highlighting the need for policy interventions aimed at mitigating cost sharing after trauma.
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