Patient-reported financial toxicity in multiple sclerosis: Predictors and association with care non-adherence

Abstract

Background: Multiple sclerosis (MS) results in considerable financial burdens due to expensive treatment and high rates of disability, which could both impact care non-adherence. Objective: To measure financial toxicity in MS patients, identify its predictors and association with care non-adherence. Methods: Adult MS patients visiting neurology clinic (June 2018 to February 2019) were consented to complete a survey. Financial toxicity was measured using Comprehensive Score for Financial Toxicity (COST) (range: 0–44, the lower the score, the worse the financial toxicity). Independent predictors of financial toxicity were identified using linear regression. Associations of COST score with patient outcomes were assessed. Results: The mean COST score in 243 recruited patients was 17.4 ± 10.2. In response to financial burdens, 66.7% and 34.7% reported life-style altering behaviors or care non-adherence, respectively. Higher financial self-efficacy was associated with less financial toxicity (coefficient, 1.33 (95% confidence interval (CI), 1.02–1.64); p < 0.001). At least one relapse in the last 3 months was associated with greater financial toxicity (coefficient, −3.34 (95% CI, −6.66 to −0.01); p = 0.049). Greater financial toxicity correlated with life-style-altering coping strategy use ( p < 0.001), care non-adherence ( p = 0.001), and worse health-related quality of life (HRQOL) ( p = 0.03). Conclusion: MS patients with lower financial self-efficacy and prior relapse history are at higher risk for financial toxicity, with associated care non-adherence and lower HRQOL.

The Coronavirus Disease 2019 (COVID-19) Pandemic: A Patient-Centered Model of Systemic Shock and Cancer Care Adherence

“…Self-efficacy plays a moderating role in the relationship between depression and distress in cancer patients. Financial self-efficacy (ie, confidence in managing money) independently predicts financial hardship among cancer patients and their caregivers and among multiple sclerosis patients [18]. We posit that high general or financial self-efficacy predicts improved well-being [17] and lower prevalence of care nonadherence, promoting resilience during a systemic stressor that mitigates its deleterious effects.…”

Palliative care needs of patients with multiple sclerosis in southeast Iran

“…67% of patients used at least one financial coping strategy in response to the financial burden of treatment expenses. Furthermore, 50.4% of the participants decreased spending on leisure activities, and 34.8% decreased basic spending [40,41]. MS patients, especially, faced considerable financial hardship due to the expensive treatments, higher rates of disability, and reduction in income.…”

Predictors of oral chemotherapy adherence at home among Chinese cancer patients: An observational prospective study

“…Compared to those patients with medium and high household income, patients with low household income were 2.3 times more likely to delaying healthcare access (J. Ma et al, 2012) and reported worse adherence of healthcare service (Sadigh et al, 2020).…”