ParticipantsGelareh Sadigh, MD, Atlanta, GA (Presenter) Research funded, TailorMed Medical Inc
Jeffrey Switchenko, PhD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Neil Lava, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Richard Duszak JR, MD, Atlanta, GA (Abstract Co-Author) Advisor, Ethos Medical, Inc; Shareholder, Ethos Medical, Inc
Richard Duszak JR, MD, Atlanta, GA (Abstract Co-Author) Advisor, Ethos Medical, Inc; Shareholder, Ethos Medical, Inc
Elizabeth A. Krupinski, PhD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Carolyn C. Meltzer, MD, Atlanta, GA (Abstract Co-Author) Nothing to Disclose
Danny Hughes, PhD, Reston, VA (Abstract Co-Author) Nothing to Disclose
Ruth C. Carlos, MD, MS, Ann Arbor, MI (Abstract Co-Author) In-kind support, Reed ElsevierEditor, Reed Elsevier
gsadigh@emory.edu
PURPOSETo assess longitudinal changes in health-related financial toxicity (FT) in multiple sclerosis (MS) patients and their impact on care non-adherence.
METHOD AND MATERIALSAdult patients with new or established diagnoses of MS visiting an outpatient neurology clinic were prospectively recruited. FT was measured at baseline, 3, 6, 9 and 12 months using the Comprehensive Score for Financial Toxicity (COST) score (range 0-44, the lower the score, the worse the FT). Independent correlates of FT and changes in FT over time were identified using linear regression. Cost-related care non-adherence was defined as patients reporting delaying, forgoing, or changing MS medications, office visits, laboratory, and imaging testing due to cost concerns. Associations of overall care non-adherence (at any time point) with baseline COST scores and changes in adherence compared with changes in COST scores at baseline and 12 months were assessed using ANOVA.
RESULTSIn all, 242 patients were recruited (43±13 years; 77% female; 47% White). Mean COST scores at baseline and 12 months were 17.4±10.1 and 19.4±11.1, respectively (P=0.09). Baseline financial self-efficacy (i.e., confidence in managing money) was the only independent predictor of COST that remained significant at all time points (B coefficient, 1.15 [95% CI, 0.89-1.41] at baseline; and 0.99 [95%CI, 0.54-1.43]) at 12 months; P<0.001). No independent predictors for changes in COST score were identified. Overall, 85% reported care non-adherence. Patients with care non-adherence had significantly greater FT at baseline (mean COST, 13.3) compared to those without care non-adherence (23.9) (P<0.001). Patients with improved adherence at 12 months reported a mean improvement of 7.8 in FT vs. those with persistent (mean -0.39 change in FT) and worsened non-adherence at 12 months (mean 0.6 change in FT) (p=0.007).
CONCLUSIONAlthough patients with MS are at high risk for FT, their degree of FT does not change over time. However, changes in FT as an adverse event of care is associated with changes in care (including imaging) non-adherence.
CLINICAL RELEVANCE/APPLICATIONFinancial self-efficacy is a predictor of FT. Targeting interventions to improve financial self-efficacy may reduce FT and improve both clinical care and imaging non-adherence.