Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin 9054, New Zealand.
BMC Med Res Methodol. 2011 Apr 13;11:45. doi: 10.1186/1471-2288-11-45.
Estimating costs is essential to the economic analysis of health care programs. Health care costs are often captured from administrative databases or by patient report. Administrative records only provide a partial representation of health care costs and have additional limitations. Patient-completed questionnaires may allow a broader representation of health care costs; however the validity and feasibility of such methods have not been firmly established. This study was conducted to assess the validity and feasibility of using a patient-completed questionnaire to capture health care use and costs for patients with osteoarthritis, and to compare the research costs of the data-capture methods.
We designed a patient questionnaire and applied it in a clinical trial. We captured equivalent data from four administrative databases. We evaluated aspects of the questionnaire's validity using sensitivity and specificity, Lin's concordance correlation coefficient (ρ(c)), and Bland-Altman comparisons.
The questionnaire's response rate was 89%. Acceptable sensitivity and specificity levels were found for all types of health care use. The numbers of visits and the majority of medications reported by patients were in agreement with the database-derived estimates (ρ(c) > 0.40). Total cost estimates from the questionnaire agreed with those from the databases. Patient-reported co-payments agreed with administrative records with respect to GP office transactions, but not pharmaceutical co-payments. Research costs for the questionnaire-based method were less than one-third of the costs for the databases method.
A patient-completed questionnaire is feasible for capturing health care use and costs for patients with osteoarthritis, and data collected using it mostly agree with administrative databases. Caution should be exercised when applying unit costs and collecting co-payment data.
估计成本对于医疗保健计划的经济分析至关重要。医疗保健成本通常从行政数据库或患者报告中获取。行政记录仅提供医疗保健成本的部分代表性，并且具有其他限制。患者完成的问卷可能允许更广泛地代表医疗保健成本；但是，这些方法的有效性和可行性尚未得到牢固确立。本研究旨在评估使用患者完成的问卷来捕获骨关节炎患者的医疗保健使用和成本的有效性和可行性，并比较数据捕获方法的研究成本。
我们设计了一份患者问卷，并在临床试验中进行了应用。我们从四个行政数据库中捕获了等效数据。我们使用灵敏度和特异性、林氏一致性相关系数（ρ（c））和 Bland-Altman 比较来评估问卷的有效性的各个方面。
问卷的回复率为 89％。对于所有类型的医疗保健使用，都发现了可接受的灵敏度和特异性水平。患者报告的就诊次数和大多数药物与数据库派生的估计值一致（ρ（c）> 0.40）。来自问卷的总成本估计值与来自数据库的一致。与药品自付额相比，患者报告的 GP 办公室交易的自付额与行政记录相符。基于问卷的方法的研究成本不到数据库方法的三分之一。
患者完成的问卷适用于捕获骨关节炎患者的医疗保健使用和成本，并且使用它收集的数据与行政数据库大多相符。在应用单位成本和收集自付额数据时应谨慎。
