Evaluation of the comprehensive score for financial toxicity measure in a multicenter cohort of adults with advanced liver disease.

BACKGROUND

This study evaluates the psychometric properties of the COmprehensive Score for financial Toxicity (COST) measure in a multicenter cohort of patients with advanced liver disease (AdvLD).

METHODS

Between April 12, 2023, and April 30, 2024, a sample of adults undergoing liver transplantation evaluation was recruited from 13 U.S. transplant centers. We evaluated structural validity using factor analysis and internal consistency reliability using Cronbach's alpha. Construct validity was assessed by examining correlations between the COST measure, health-related unmet social needs, and EQ-5D-5L scores.

RESULTS

Among the 459 participants, more than half were male (59%), White (82%), and not Hispanic or Latino (77%). Approximately 44% were unable to work due to illness or disability, and over 44% had an annual household income below $50,000. The COST measure demonstrated suboptimal structural validity based on both one- and two-factor models. Cronbach's alpha for the COST measure was 0.84. The total COST score showed mild to moderate correlations with health-related unmet social needs (r: -0.21 to -0.41) and small correlations with the EQ-5D-5 L visual analogue scale (r = 0.24) and pattern scores (r = 0.34).

DISCUSSION: Caution may be warranted when applying COST to patients with AdvLD, as suboptimal structural and construct validity compromise score interpretation and clinical utility. Future studies should systematically review evidence on its psychometric properties and evaluate content validity through cognitive interviews with patients with AdvLD.