Background
Methods
Questionnaire development
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The less regularly an event occurs and the lower its subjective impact is, the less likely it is to be recalled exactly over the longer time frame [22].
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Techniques of "bounded recall" should be used if possible [24]. This means, that the time horizon is explicitly defined by exact dates and, for repeated measurements, the preceding answers and already recalled events should be shown.
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Closed questions should be used if possible in order to support the effects of recognition [27].
Cost component | Parameter | Recall period | Valuation* |
---|---|---|---|
Utilization of paid and unpaid help | Nature of help, duration (hours), outlays | 4 weeks | Mean gross wage of a housekeeper |
Travel expenses | Type of transportation, number of rides, cost (if public transportation) or kilometers (car) | 4 weeks | Outlays (public transportation), official schedule of travel expenses (car) |
Physical activities, gym activities | Type of activity, average number per week, duration, outlays | 4 weeks | Average prices per activity |
Physician services | Specialization of physician, number of consultations, services performed | 12 weeks | Mean reimbursement per consultation |
Intake of prescribed medication | Name of medication, current daily dosage, changes in medication or dosage | 12 weeks | Official pharmaceutical price list |
Intake of unprescribed medication | Name of medicine, number and size of packages purchased | 12 weeks | Official pharmaceutical price list |
Physical therapeutics/non-physician services | Type and number of services | 12 weeks | Pricing schedule of statutory health insurance |
Alternative care | Type and number of services, outlays | 12 weeks | Outlays or price schedule of alternative care |
Medical products | Type of product, outlays/cost | 12 weeks | Average market prices |
Change in diet | Type of dietary changes, estimated additional outlays | 12 weeks | Outlays estimated by patients |
Lost productive time | Reason for lost productive time, duration | 12 weeks | Average sex- and age-adjusted labor costs |
Inpatient stay | Reason for inpatient treatment, duration | 12 weeks | Average per diem rates** |
Practicability/acceptability
Completeness and face validity
Convergent validity
Criterion validity
Study design
Statistical analysis
Ethics
Results
Patients
Age (years) |
Insurance status
| ||
---|---|---|---|
Mean (SD) | 55 (7.6) | Statutory health insurance | 91 (86%) |
Range | 30–65 | Private health insurance | 13 (12%) |
Sex
| n.a. | 2 (2%) | |
Male | 90 (85%) |
Diagnosis
| |
Female | 16 (15%) | Myocardial infarction | 54 (51%) |
Vocational education
| CABG | 45 (42%) | |
No | 4 (4%) | Angina | 7 (7%) |
Vocational training | 52 (49%) |
Duration of disease since diagnosis (months)
| |
Technical school | 23 (22%) | ||
University/technical college | 21 (20%) | Mean (SD) | 20.6 (47.7) |
Other/n.a. | 6 (6%) | Range | 0.5–264 |
Persons in household
|
NYHA classification
| ||
Mean (SD) | 2,7 (1,2) | class I | 88 (83%) |
Range | 1–6 | class II | 10 (9%) |
Employment status
| class III | 3 (3%) | |
Full time | 66 (62%) | class IV | 0 |
Less than full time | 4 (9%) | n.a. | 5(5%) |
Unemployed | 3 (3%) |
Self-rated health 3 months after rehabilitation (VAS)
| |
Early retirement | 9 (8%) | ||
Regular retirement | 16 (15%) | Mean (SD) | 78.6 (15.8) |
Other/n.a. | 1 (1%) | Range | 30–100 |
Feasibility and acceptability
Convergent validity
Retrospective cost questionnaire | Cost diary | ICC | p** | |
---|---|---|---|---|
Mean (SD) | Mean (SD) | |||
Number of physician visits | 1.9 (1.9) | 2.2 (2.2) | 0.64 | 0.13 |
Inpatient days | 0.54 (2.1) | 0.54 (2.0) | 0.90 | 0.99 |
Days off work | 13.8 (14.9) | 15.7 (14.0) | 0.77 | 0.06 |
Number of drugs | 4.1 (1.5) | 3.9 (1.4) | 0.72 | 0.09 |
Cost of medical intake (€) | 2.9 (1.5) | 2.6 (1.3) | 0.57 | 0.04 |
Cost of medical aids (€) | 162.3 (258.6) | 175.5 (264.6) | 0.72 | 0.52 |
Reliability analysis | Medication (sales name) | Medication (generic name/agent) | |
Questionnaire | Diary | ||
Yes | Yes | 274 (61.3%) | 325 (80.8%) |
Yes | No | 77 (17.2%) | 28 (7.0%) |
No | Yes | 95 (21.3%) | 48 (11.9%) |
No | No | 1** (0.2%) | 1** (0.2%) |
Criterion validity
Retrospective cost questionnaire | Sickness fund data | Zero difference (+/- 1) | ICC | p* | |
---|---|---|---|---|---|
Mean (SD) | Mean (SD) | n (%) | |||
Days off work hospitalized | 1.8 (7.45) | 1.8 (7.5) | 42 (87.5) | 0.92 | 0.92 |
Days off work not hospitalized | 25.3 (33.4) | 29.1 (33.5) | 25 (52.1) | 0.94 | 0.03 |
Total days of sick leave | 27.2 (35.2) | 30.9 (34.9) | 29 (60.4) | 0.94 | 0.03 |
Health care and disease-related costs
Percent | Mean | SD | Range | Skewness | |
---|---|---|---|---|---|
Direct medical cost*
|
13.1%
|
1,050.5
|
1,767.5
|
83.9–14070.8
|
5.24
|
Hospitalization | 43.5% | 457.0 | 1714.7 | 0.0–13,865.6 | 6.07 |
Prescription drugs | 23.8% | 250.3 | 119.6 | 26.9–778.6 | 1.27 |
Medical aids | 18.9% | 198.5 | 408.0 | 0.0–3,236.4 | 5.02 |
Physician | 12.7% | 133.0 | 232.4 | 0.0–1726.0 | 5.12 |
Non-prescription drug | 0.8% | 8.1 | 51.1 | 0.0–470.7 | 8.45 |
Courses | 0.2% | 2.0 | 11.2 | 0.0–77.2 | 5.74 |
Alternative care | 0.1% | 1.5 | 9.2 | 0.0–76.7 | 7.08 |
Non-medical cost*
|
2.6%
| 212.2 | 357.7 |
0.0–2,112.4
| 3.52 |
Services (paid/unpaid) | 52.4% | 111.2 | 341.1 | 0.0–2,036.9 | 4.08 |
Activities | 20.3% | 43.2 | 41.8 | 0.0–196.2 | 0.56 |
Additional cost for diet | 18.7% | 39.6 | 87.9 | 0.0–385.8 | 2.40 |
Travel expenses | 8.6% | 18.2 | 40.9 | 0.0–277.8 | 3.76 |
Indirect cost*
|
84.2%
| 6,754.0 | 8,433.5 |
0.0–2,1673.7
| 0.77 |
Time off work for physician visits | 0.3% | 18.6 | 53.8 | 0.0–273.4 | 3.10 |
Time off work | 99.7% | 6,735.5 | 8,434.9 | 0.0–21,804.5 | 0.77 |
Total cost | 100.0% | 8,016.8 | 9,122.5 | 83.9–34,522.0 | 0.85 |