Abstract Background Financial toxicity has emerged as a major yet frequently overlooked burden among patients with inflammatory bowel disease (IBD), particularly in the era of advanced therapies. Real-world evidence quantifying the economic strain of IBD treatment pathways remains limited. This study aimed to assess the prevalence, identify the determinants and evaluate the consequences of financial toxicity in a large tertiary-centre cohort 1. Methods This retrospective study included 2, 000 adults followed from January 2020 to August 2025. Financial toxicity was measured using the validated Comprehensive Score for Financial Toxicity (COST) 2, supplemented by out-of-pocket (OOP) medical and non-medical expenditures, income loss and treatment-related travel costs. Patients were stratified according to treatment class. Primary outcome was moderate-to-severe financial toxicity (COST score 18). Secondary outcomes included cost-related non-adherence and reduced work productivity. Multivariable logistic regression identified independent predictors of financial toxicity. COST score distributions across treatment classes are illustrated in Figure 1. Results Among 2, 000 patients (1, 380 with ulcerative colitis and 620 with Crohn’s disease), moderate-to-severe financial toxicity was identified in 38% of the cohort. Prevalence differed substantially across treatment classes: anti-TNF (48%), vedolizumab (44%), ustekinumab (37%), JAK inhibitors (29%) and conventional therapy (22%) (p 0. 001). Median annual OOP costs were highest among anti-TNF (1, 520) and vedolizumab users (1, 460). Cost-related non-adherence occurred in 21% of patients, most frequently among anti-TNF users 3. Independent predictors of financial toxicity included biologic therapy (OR 2. 6; 95% CI 2. 1–3. 2), annual travel frequency (OR 1. 4 per 5 visits), income below the national median (OR 2. 9) and ≥1 hospitalisation per year (OR 1. 7) (all p 0. 01). Financial toxicity was independently associated with reduced work productivity and cost-related non-adherence (p 0. 001). Conclusion ConclusionsFinancial toxicity is a common and clinically meaningful burden in IBD, disproportionately affecting patients receiving infusion-based biologics. Low income, high healthcare utilisation and substantial travel burden are major contributors. These findings support routine financial toxicity screening and incorporation of economic considerations into shared decision-making 4. References: 1. Zafar SY, Abernethy AP. Financial toxicity in health care: exploring the burden. Oncologist. 2013;18: 381–382. 2. de Souza JA, Yap BJ, Hlubocky FJ, et al. The development of a financial toxicity PRO: the COST measure. Cancer. 2014;120: 3245–3253. 3. Long MD, et al. Barriers to care and adherence in IBD. Clin Gastroenterol Hepatol. 2022;20: 1234–1243. 4. Park KT, et al. Health economic impact of IBD care pathways. Conflict of interest: Özden, Yavuz: Grants: No – The author has received no grants. Personal Fees: No – The author has received no personal fees. Consulting: No – The author has not provided consulting services. Support for travel for meetings to support study: No – The author has received no travel support. Shareholder: No – The author holds no relevant shares. Fees for participation in review activities (data monitoring boards, statistical analysis, endpoint committees, etc. ): No – The author has not participated in any paid review activities. Payment for writing or reviewing the manuscript: No – The author has received no payment for writing or reviewing. Non-financial support: No – The author has received no non-financial support. Provision of writing assistance, medicines, equipment, or administrative support: No – The author has received no such support. Other: No – No other conflicts of interest are present. The author declares no conflicts of interest.
Y Özden (Thu,) studied this question.