Development and Validation of an Instrument to Measure Health-Related Out-of-Pocket Costs: The Cost for Patients Questionnaire

Laberge, Maude; Coulibaly, Lucien P.; Berthelot, Simon; Silva, Roxane Borgès Da; Guertin, Jason R.; Strumpf, Erin; Poirier, Annie; Zomahoun, Hervé Tchala Vignon; Poder, Thomas G.

doi:10.1016/j.jval.2021.03.016

Cited by 8 publications

(17 citation statements)

References 40 publications

(53 reference statements)

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“…Our results compare well with a previous pilot test-retest conducted on the CoPaQ with a small sample (n = 18). The results of this pilot showed that the ICC varied from À0.02 to 0.99 (median 0.62) and the Kappa coefficients varied from À0.11 to 1.00 (median 0.86) (17). These results suggested that the pilot version of the CoPaQ had a moderate to good reliability in terms of ICC and gives consistent results between the two measurement periods in terms of Kappa coefficients.…”

Section: Discussionmentioning

confidence: 99%

“…A small pilot test-retest was carried out in a previous study with eighteen participants. Based on these pilot data (17) and the number of people in Quebec, 385 participants were targeted in the recruitment. This sample size was estimated by setting respectively the statistical power and alpha risk at 95 and 5 percent for a Quebec population of 6.9 million adults.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…The CoPaQ is a comprehensive tool to measure direct and indirect out-of-pocket costs of a health condition for patients and their families to various outpatient contexts (17). This tool was developed after a systematic review (19).…”

Section: Instrument/questionnairementioning

confidence: 99%

“…Following the Delphi process, a small pilot test-retest was carried out with eighteen new participants on two different occasions separated by a 2-week interval (17). The participants of the pilot met the same eligibility criteria as patients from the Delphi panel (17). The pilot test-retest allowed to calculate the ICC and Kappa coefficients and to identify the items that lack clarity or that may not be appropriate for, or discriminate between respondents (10).…”

Section: Instrument/questionnairementioning

confidence: 99%

“…The pilot test-retest allowed to calculate the ICC and Kappa coefficients and to identify the items that lack clarity or that may not be appropriate for, or discriminate between respondents (10). Six items that presented comprehension problems were identified and subsequently revised, and three items were removed (17). The CoPaQ is composed of forty-one items and subdivided into eight categories: (i) the patient's costs (sixteen items), (ii) the time spent on accessing medical services (two items), (iii) the costs related to workforce participation (two items), (iv) the patient's financial distress (one item), (v) the informal caregiver's costs (seven items), (vi) the informal caregiver's timer not directly related to medical services (three items), (vii) the patient's sociodemographic characteristics (nine items), and (viii) a note to researchers (web link to complete the EQ-5D-5L questionnaire, one item).…”

Section: Instrument/questionnairementioning

confidence: 99%

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Test–retest reliability of the Cost for Patients Questionnaire

Poder¹,

Coulibaly²,

Hassan³

et al. 2022

Int J Technol Assess Health Care

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Objectives: To investigate the test-retest reliability of the Costs for Patients Questionnaire (CoPaQ). Methods: Through an online survey, individuals were invited to participate in a two-step study to assess the test-retest reliability of the CoPaQ. Participants to the first step were invited to complete the questionnaire a second time 2 weeks after. Reliability was assessed by calculating Cohen's Kappa coefficients and intraclass correlation coefficients (ICC) for discrete and continuous data, respectively. A sensitivity analysis was carried out. Results: From a total of 1,200 participants who completed the first test, 403 completed the second test. The ICC varied from À0.00 to 0.98 with poor, moderate, good, and excellent results. The Kappa coefficients varied from À0.004 to 0.65 and were poor, slight, fair, moderate, and substantial. The sensitivity analysis showed the median value of ICC and Kappa coefficients for each category before and after the outliers' exclusion. The median value of ICC changed from 0.30 (before) to 0.70 (after), and from 0.12 (before) to 0.04 (after), respectively, for each category. The median value of the Cohen's Kappa coefficient increased from 0.44 (before) to 0.46 (after) and decreased from 0.32 (before) to 0.30 (after), respectively. Conclusions: Test-retest reliability results indicated that the CoPaQ has a moderate reliability in terms of ICC and Kappa coefficients. The moderate reliability observed gives additional support for the applicability of this tool in economic evaluations of health interventions. Additional studies including on other properties and a cultural adaptation could further enhance the use of the tool.

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Section: Discussionmentioning

confidence: 99%

Section: Sample Size Calculationmentioning

confidence: 99%

Section: Instrument/questionnairementioning

confidence: 99%

Section: Instrument/questionnairementioning

confidence: 99%

Section: Instrument/questionnairementioning

confidence: 99%

See 3 more Smart Citations

Test–retest reliability of the Cost for Patients Questionnaire

Poder¹,

Coulibaly²,

Hassan³

et al. 2022

Int J Technol Assess Health Care

Self Cite

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Cohort profile: A multicenter evaluation of clinical decision rules applied to emergency department triage of patients presenting with acute respiratory infection or infectious diarrhea

Berthelot,

Boissinot,

Bergeron

et al. 2023

Preprint

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PurposeEmergency department (ED) patients suffering from acute respiratory infection or infectious diarrhea often present with self-limiting conditions. The study objective was to evaluate the performance of triage clinical decision rules consisting of a rapid molecular test and a self-administered patient questionnaire to identify ED patients who can self-treat at home without consulting an emergency physician. This article describes the profile of the cohorts recruited.ParticipantsParticipants were prospectively recruited in 4 EDs in Québec City and Montréal, Canada, from February 2022 through March 2023. Participants were aged ≥18 years, had an acute respiratory infection and/or acute infectious diarrhea, and had received a Canadian Triage and Acuity Scale score between 3 (urgent) and 5 (non-urgent). Participants were asked to complete a self-administered risk stratification questionnaire after triage and to follow usual ED care afterward. Nasopharyngeal and/or rectal swabs were collected and frozen for subsequent testing on a rapid molecular testing device. Data were obtained during the recruitment visit, during a follow-up phone call 7 days later and from medical records. The primary outcome to be predicted by the clinical decision rules was an aggregation of hospitalization, return visit and mortality at 7 days.Findings to dateWe recruited 1,391 participants, 62.3% of whom were women, 80.7% were aged under 60, 78.2% had no comorbidities, 76.5% presented with an acute respiratory infection, 17.8% with an acute infectious diarrhea and 5.7% with both. Hospitalization and return visits incidence proportions at 7 days were respectively 10.8% and 13.1% for respiratory infections and 14.1% and 16.5% for infectious diarrhea. No death was recorded.Future plansThe data gathered from these cohorts will enable us to test, refine, derive, and validate clinical decision rules used to help ED triage nurses offer the most suitable care to patients presenting with acute respiratory infections or infectious diarrhea.Strengths and limitationsOur study has both strengths and limitations. Among the strengths:The cohorts were recruited from 4 different EDs and reached the target sample size for acute respiratory infections and acute infectious diarrhea.The potential economic impact of the clinical decision rules will be assessed from the perspective of both the health system and the patient.The main limitations are the following.Cohorts were recruited by convenience sampling and may not be representative of the entire ED population.The patient self-administered questionnaires used in this study were derived from systematic reviews and rapid prototyping, but not according to the methodological standards recommended for the derivation of clinical decision rules. However, the study dataset was built to enable rules to be refined and if necessary, new rules to be derived and internally validated.We recorded a 12.9% loss of participants at the 7-day follow-up phone call. However, the primary outcome measures (return visits, admissions and deaths) will be obtained from provincial administrative databases. These reliable data will enable us to overcome this limitation for future projects to refine and validate robust triage clinical decision rules.

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Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

Dahal,

Rawal,

Ademi

et al. 2023

MDM Policy & Practice

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Background. This study aimed to estimate the health care expenditure for managing type 2 diabetes (T2D) in the community setting of Nepal. Methods. This is a baseline cross-sectional study of a heath behavior intervention that was conducted between September 2021 and February 2022 among patients with T2D ( N = 481) in the Kavrepalanchok and Nuwakot districts of Nepal. Bottom-up and micro-costing approaches were used to estimate the health care costs and were stratified according to residential status and the presence of comorbid conditions. A generalized linear model with a log-link and gamma distribution was applied for modeling the continuous right-skewed costs, and 95% confidence intervals were obtained from 10,000 bootstrapping resampling techniques. Results. Over 6 months the mean health care resource cost to manage T2D was US $22.87 per patient: 61% included the direct medical cost (US $14.01), 15% included the direct nonmedical cost (US $3.43), and 24% was associated with productivity losses (US $5.44). The mean health care resource cost per patient living in an urban community (US $24.65) was about US $4.95 higher than patients living in the rural community (US $19.69). The health care costs per patient with comorbid conditions was US $22.93 and was US $22.81 for those without comorbidities. Patients living in rural areas had 16% lower health care expenses compared with their urban counterparts. Conclusion. T2D imposes a substantial financial burden on both the health care system and individuals. There is a need to establish high-value care treatment strategies for the management of T2D to reduce the high health care expenses. Highlights More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes. Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities. The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.

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Development and Validation of an Instrument to Measure Health-Related Out-of-Pocket Costs: The Cost for Patients Questionnaire

Cited by 8 publications

References 40 publications

Test–retest reliability of the Cost for Patients Questionnaire

Test–retest reliability of the Cost for Patients Questionnaire

Cohort profile: A multicenter evaluation of clinical decision rules applied to emergency department triage of patients presenting with acute respiratory infection or infectious diarrhea

Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective

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