Patel Minal R, Troost Jonathan P, Heisler Michele, Carlozzi Noelle E
Department of Health Behavior and Health Equity, University of Michigan, 1415 Washington Heights, SPH 1, Room 3810, Ann Arbor, MI, 48109, USA.
Michigan Institute for Clinical Health Research, University of Michigan, 1600 Huron Pkwy, Ann Arbor, MI, 48105, USA.
J Patient Rep Outcomes. 2025 Jan 6;9(1):2. doi: 10.1186/s41687-024-00834-5.
This study aims to improve the interpretability and clinical utility of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) by identifying distinct financial toxicity classes in adults with diabetes.
Data included a sample of 600 adults with Type 1 or Type 2 diabetes and high A1c. Latent Class Analysis was used to identify subgroups of patients based on COST-FACIT score patterns.
We identified 3 financial toxicity classes (high, medium and low) with strong indicators of membership classification. Multiple indicators of financial stress, maladaptive cost-coping behaviors, more comorbidities, more prescribed medications, more diabetes distress, more depressive symptoms, closer to the federal poverty level, female, having lower educational attainment and being single were all significant predictors of high financial toxicity class membership. A score of 26 on the COST-FACIT was the strongest threshold for sorting high vs. medium/low financial toxicity, with a positive predictive value (PPV) of 76% and negative predictive value (NPV) of 93%.
The COST-FACIT can be used to reliably identify people with diabetes that have high financial toxicity. Integrating this new cut-score into clinical practice may help clinical teams identify people in need of additional support due to financial toxicity.
本研究旨在通过识别糖尿病成人患者中不同的财务毒性类别，提高财务毒性综合评分-慢性病治疗功能评估（COST-FACIT）的可解释性和临床实用性。
数据包括600名1型或2型糖尿病且糖化血红蛋白（A1c）较高的成人样本。采用潜在类别分析根据COST-FACIT评分模式识别患者亚组。
我们识别出3个财务毒性类别（高、中、低），并具有强有力的成员分类指标。财务压力、适应不良的成本应对行为、更多合并症、更多处方药物、更多糖尿病困扰、更多抑郁症状、更接近联邦贫困水平、女性、教育程度较低以及单身等多项指标都是高财务毒性类别成员的显著预测因素。COST-FACIT评分为26是区分高财务毒性与中/低财务毒性的最强阈值，阳性预测值（PPV）为76%，阴性预测值（NPV）为93%。
COST-FACIT可用于可靠识别具有高财务毒性的糖尿病患者。将这一新的切点分数纳入临床实践可能有助于临床团队识别因财务毒性而需要额外支持的患者。
