Financial Toxicity in Women with Endometriosis: Psychometric Validation of the Polish COST-FACIT with Analysis of Demographic and Clinical Factors

Katarzyna Pietrzak, Anna Weronika Szablewska, Arkadiusz Prajzner, Aleksandra Gaworska-Krzemińska, Bartosz Pryba
In: Healthcare · 2026 · vol. 14(11) , pp. 1449 · doi:10.3390/healthcare14111449 · W7162238671
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

The Polish COST-FACIT scale was validated for women with endometriosis, revealing that longer symptom duration, distance to care, and healthcare costs correlated with financial toxicity, while education, employment, and income were associated with better financial well-being.

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Abstract

Background: Endometriosis is a chronic condition associated with substantial healthcare costs, diagnostic delays and long-term impairment in quality of life. Despite the recognized economic burden, patient-reported financial distress remains insufficiently studied. The aim of this study was to adapt and validate the Polish version of the Comprehensive Score for Financial Toxicity (COST-FACIT) for use in women with endometriosis, as well as to examine demographic and clinical factors associated with financial toxicity. Methods: A cross-sectional study was conducted among Polish women with endometriosis using an online survey. The COST-FACIT was adapted following standard forward–backward translation procedures, with FACIT approval. Psychometric evaluation included internal consistency, construct validity, convergent validity with the Financial Well-Being Scale, and test–retest reliability. Exploratory and confirmatory factor analyses were performed, and multivariable models were used to identify factors associated with financial toxicity. Results: The adapted scale demonstrated good psychometric properties, with excellent internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.92) and strong test–retest reliability (r = 0.87). Exploratory factor analysis supported a two-factor structure of the instrument. COST-FACIT scores were strongly correlated with financial well-being (r = 0.78). Higher education, stable employment and higher income were associated with better financial well-being, whereas longer symptom duration, greater distance to care and higher healthcare expenditures were associated with worse scores. Conclusions: The Polish COST-FACIT demonstrated good psychometric properties and may serve as a useful instrument for assessing financial toxicity in women with endometriosis. The results highlight the financial burden of the disease and support the use of patient-reported measures to identify individuals at risk of financial distress and reduced quality of life. This tool may facilitate clinical research and improve patient-centered care.

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endometriosis

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