Development and first assessment of a questionnaire for health care utilization and costs for cardiac patients

Background: The valid and reliable measurement of health service
utilization, productivity losses and consequently total
disease-related costs is a prerequisite for health services
research and for health economic analysis. Although administrative
data sources are usually considered to be the most accurate, their
use is limited as some components of utilization are not
systematically captured and, especially in decentralized health
care systems, no single source exists for comprehensive utilization
and cost data. The aim of this study was to develop and test a
questionnaire for the measurement of disease-related costs for
patients after an acute cardiac event (ACE). Methods: To design the
questionnaire, the literature was searched for contributions to the
assessment of utilization of health care resources by
patient-administered questionnaires. Based on these findings, we
developed a retrospective questionnaire appropriate for the
measurement of disease-related costs over a period of 3 months in
ACE patients. Items were generated by reviewing existing guidelines
and by interviewing medical specialists and patients. In this
study, the questionnaire was tested on 106 patients, aging 35 - 65
who were admitted for rehabilitation after ACE. It was compared
with prospectively measured data; selected items were compared with
administrative data from sickness funds. Results: The questionnaire
was accepted well (response rate = 88%), and respondents completed
the questionnaire in an average time of 27 minutes. Concordance
between retrospective and prospective data showed an intraclass
correlation (ICC) ranging between 0.57 (cost of medical intake) and
0.9 (hospital days) with the other main items (physician visits,
days off work, medication) clustering around 0.7. Comparison
between self-reported and administrative data for days off work and
hospitalized days were possible for n = 48. Respective ICCs ranged
between 0.92 and 0.94, although differences in mean levels were
observed. Conclusion: The questionnaire was accepted favorably and
correlated well with alternative measurement approaches. This first
assessment showed promising characteristics of this questionnaire
in different aspects of validity for patients with ACE. However,
additional research and more extensive tests in other patient
groups would be worthwhile.