Department of Operations and Decision Systems, Faculty of Administration, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et Pratiques optimales en santé, Québec, Canada; Vitam, Centre de recherche en santé durable - Université Laval, Québec, Canada.
Faculté des lettres et sciences humaines and Centre de Recherche sur le Vieillissement, Université de Sherbrooke, Sherbrooke, Canada.
Value Health. 2021 Aug;24(8):1172-1181. doi: 10.1016/j.jval.2021.03.016.
The growth of healthcare spending is a major concern for insurers and governments but also for patients whose health problems may result in costs going beyond direct medical costs. To develop a comprehensive tool to measure direct and indirect costs of a health condition for patients and their families to various outpatient contexts.
We conducted a content and face validation including results of a systematic review to identify the items related to direct and indirect costs for patients or their families and an online Delphi to determine the cost items to retain. We conducted a pilot test-retest with 18 naive participants and analyzed data calculating intraclass correlation and kappa coefficients.
An initial list of 34 items was established from the systematic review. Each round of the Delphi panel incorporated feedback from the previous round until a strong consensus was achieved. After 4 rounds of the Delphi to reach consensus on items to be included and wording, the questionnaire had a total of 32 cost items. For the test-retest, kappa coefficients ranged from -0.11 to 1.00 (median = 0.86), and intraclass correlation ranged from -0.02 to 0.99 (median = 0.62).
A rigorous process of content and face development was implemented for the Cost for Patients Questionnaire, and this study allowed to set a list of cost elements to be considered from the patient's perspective. Additional research including a test-retest with a larger sample will be part of a subsequent validation strategy.
医疗保健支出的增长是保险公司和政府关注的主要问题，但也是患者关注的问题，因为他们的健康问题可能导致超出直接医疗费用的成本。开发一种综合工具，以衡量患者及其家庭在各种门诊环境下的健康状况的直接和间接成本。
我们进行了内容和验证，包括系统评价的结果，以确定与患者或其家庭的直接和间接成本相关的项目，并进行在线 Delphi 调查，以确定保留的成本项目。我们对 18 名无经验的参与者进行了试点测试-重测，并分析了数据，计算了组内相关系数和 Kappa 系数。
从系统评价中建立了 34 项初始项目清单。德尔菲小组的每一轮都纳入了上一轮的反馈，直到达成强烈共识。经过四轮德尔菲调查，就纳入的项目和措辞达成共识后，问卷共有 32 项费用项目。对于测试-重测，Kappa 系数范围为-0.11 至 1.00（中位数= 0.86），组内相关系数范围为-0.02 至 0.99（中位数= 0.62）。
对《患者费用问卷》进行了严格的内容和验证开发过程，本研究确定了一组从患者角度考虑的费用要素。包括更大样本的测试-重测在内的进一步研究将成为后续验证策略的一部分。
