Kidney stone treatment is associated with financial toxicity

The team of investigators used the COST-FACIT tool to take into account both the time and money lost to treatment.

Most patients undergoing kidney stone treatment face moderate or severe financial toxicity (FT) when looking at both the time and money lost by patients due to receiving care.1

The study, published online in Urology, was conducted by a team of investigators led by Benjamin Green, BS, of Albert Einstein College of Medicine in Bronx, New York.

FT was measured using the Comprehensive Score for Financial Toxicity (COST) tool from Using a questionnaire, the tool takes into account patient-faced costs of medications, procedures, and surgeries as well as the days of productivity lost due to missing work.

The tool then administers a score ranging from 0 to 44, where lower scores indicate higher FT. For this study, moderate FT was defined as scores between 25-14 points and severe FT was defined as a score below 14.Using these parameters, investigators found that 60% of participants reported having at least moderate FT and 26% reported having severe FT. The median COST score of participants was 21, which would indicate moderate FT.

According to the authors, this is the first study known to analyze the economic stresses that patients from multiple populations face when undergoing treatment for nephrolithiasis. The cross-sectional study cohort (n = 241) consisted of 126 in-person participants and 115 online participants. The online cohort was comprised of 28 international participants and 87 American participants from 30 different states.Patients had to be 18 years or older, have at least 1 kidney stone confirmed by imaging, and have literacy in either English or Spanish to take part in the study.

Those who reported moderate to severe FT were generally younger than those with low FT by a median difference of 8 years (95% CI = 4, 12). Participants who had moderate to severe FT also tended to miss more workdays (P = .002) due to their kidney stones.

Further, the authors found an inverse relationship between out-of-pocket expenses and COST scores, where if out-of-pocket expenses increased, COST scores decreased (Spearman's rho = -0.406, P  < .001), therefore worsening the financial burden. They also found that the association between workdays missed due to kidney stones and out-of-pocket costs remained significant even after controlling for baseline demographic characteristics.

Within the cohort, 20% (n = 48) respondents reported that they did not spend any money out-of-pocket on kidney stone expenses within the past year. The highest number of participants, 24% (n = 59) spent between $100 and $499.

According to the authors, the high level of FT seen in this patient-population is comparable to the financial burdens faced by patients with cancer, for which the COST-FACIT tool was originally designed. The authors suggest that to alleviate these cost burdens, urologists should educate themselves on the costs associated with kidney stone treatment and initiate conversations with patients about their financial situation, how their insurance works, and the costs for which they are responsible. These conversations should be done in tandem with the discussion on treatment risks and benefits so that the provider can then tailor the treatment to the financial situation of the patient.


1. Green B, Labagnara K, Feiertag N, et al. Financial toxicity of nephrolithiasis: the first assessment of the economic stresses of kidney stone treatment. Urology. Published online September 29, 2022.