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

Gelareh Sadigh, Neil Lava, Jeffrey Switchenko, Richard Duszak, Elizabeth A. Krupinski, Carolyn Meltzer, Danny Hughes, Ruth C. Carlos

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)453-464
Number of pages12
JournalMultiple Sclerosis Journal
Issue number3
StatePublished - Mar 2021


  • Multiple sclerosis
  • care non-adherence
  • financial toxicity
  • health-related quality of life
  • outcomes

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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