Financial Toxicity and Cost-Related Imaging Nonadherence in Pediatric Outpatient Imaging

Financial toxicity, defined as the financial burden and stress experienced due to medical costs, is increasingly recognized as a key patient-reported outcome and has been linked to cost-related non-adherence in adult populations. However, its prevalence and impact in pediatric imaging are unknown. We examined the prevalence and predictors of financial toxicity among families of children undergoing outpatient imaging and its association with imaging non-adherence.

We conducted a prospective cross-sectional survey of parental caregivers of children (<18 years of age) undergoing outpatient imaging at two free standing children's hospitals in the U.S. (July 2024-May 2025). Financial toxicity was measured using the adapted FACIT-COST instrument and scores <26 indicated high financial toxicity. Multivariable logistic regression examined associations between family characteristics and high financial toxicity.

Among 399 caregivers, the mean FACIT-COST score was 24.6 (SD 10.2), and 49% were categorized as having high financial toxicity. Advanced imaging (CT, MRI, or multimodality examinations) was associated with higher odds of high financial toxicity compared with non-advanced imaging (aOR 1.80; 95% CI 1.06-3.07). Lower household income was strongly associated with high financial toxicity. Families with high financial toxicity were more likely to report prior cost-related imaging non-adherence (10.6% vs 3.0%; p=0.003).

High financial toxicity was common among families undergoing pediatric outpatient imaging and was associated with cost-related imaging non-adherence. Screening during imaging encounters may help identify families at risk.