AbstractIntroductionThe care required to recover serious burn injuries is costly. In the US, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors.MethodsFinancial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity).Results644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers’ compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368 - 1,728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, p< 0.001) and 12-months post-injury (coefficient -0.001, p=0.004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval.ConclusionsParticipants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury.Applicability of Research to PracticeFinancial toxicity is a real phenomenon in burn survivors. Burn care providers should be attuned to their patients' finances and spending and connect them with resources when appropriate.