Single Question from COST Tool Accurately Screens for Financial Toxicity in Outpatient Imaging

One question — 'My illness has been a financial hardship to me and my family' — identifies financial toxicity in outpatient imaging patients with AUC 0.89–0.90, matching the full 11-item COST score (Spearman r=0.75). Valid even among patients who canceled appointments (AUC 0.88–…

• Secondary analysis of 709 outpatient imaging patients (427 completed, 282 canceled); item response theory showed high discrimination for the single item (α=3.40), supporting its ability to capture a broad spectrum of financial toxicity severity.
• Performance was consistent across both completed and canceled appointment groups, suggesting utility for capturing financially vulnerable patients who may disengage from care.
• Key limitation: secondary analysis design with potential selection bias; external validation in diverse health systems and imaging settings has not yet been reported.

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