Background:Out-of- pocket (OOP) health payment is the least efficient and most inequitable means of financing health care. In Ethiopia from the total health expenditure, OOP payment by household accounts 31 % which is more than the recommended 20%. Even though there arernstudies conducted on burden of OOP due to deferent NCDs like, cardiovascular disease, Cancer,rndiabetes mellitus and mental illness, there is no figure regarding the financial burden of OOPrnexpenditure due to having more than one NCD (Multimorbidity). Objective: The study assessed the impact of NCD multimorbidity on health care utilization andrnOOP expenditure at Tikur Anbesa Specialized hospital, Addis Ababa in 2020. rnMethod: Facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospitalrnfrom May 2020 to July 2020. Data was collected using pre-tested, structured intervieweradministeredrnrnquestionnaire. Data were entered using epi data version 3.1 and analyzed usingrnSTATAV 14. Binary logistic regressions, multivariable logistic regressions and negative binomialrnregression was used to examine the association between variables. Result: A total of 392 respondents were participated in this study and prevalence of NCDrnmultimorbidity was 67 % (95%CI 62.2-71.5). The frequency of OPD visits was associated withrnthe number of NCD (IRR= 1.2, 95%CI; 1.15-1.25, P-value < 0.001) and an increased number ofrnNCDs was also associated with a higher likelihood of having hospitalization (AOR= 1.5, 95%CI;rn1.19- 2.00, P-value < 0.001). We found 30.7% and 12.9% of households incurred catastrophicrnhealth expenditure (CHE) at 25% and 40% threshold of total household expenditure respectively.rnAt a threshold level of 25% and 40% of household non-food expenditure, the level of catastrophicrnpayments was 61.2% and 38.7% respectively. Conclusion and Recommendation: Multimorbid patients came to health facilities morernfrequently and they were exposed to increase financial problems. CHE mostly affected thosernhouseholds with older member, unemployed member, family member who came from outside ofrnAddis Ababa to get health care services. Respondents who were in the poorest wealth quintile,rnthose who have increased number of NCD conditions, those households with a hospitalizedrnmember, household who was not a member of an insurance system, those who use both public andrnprivate health facilities, and patients who visit a health facility frequently were affected byrnCHE.NCD multimorbid patients should be prioritized in the implementation of financial riskrnprotection mechanisms.