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Collecting Direct Non-Health Care and Time Cost Data: Application to Screening and Diagnosis of Cervical Cancer

Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, sbcantor{at}mdanderson.org

Lawrence B. Levy, MS

Department of Radiation Oncology Treatment, The University of Texas M. D. Anderson Cancer Center, Houston

Marylou Cárdenas-Turanzas, MD, DrPH

Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston

Karen Basen-Engquist, PhD

Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston

Tao Le, BS

Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston

J. Robert Beck, MD

Department of Information Technology, Fox Chase Cancer Center, Philadelphia

Michele Follen, MD, PhD

Biomedical Engineering Center, The University of Texas M. D. Anderson Cancer Center, Houston

Background. Data on direct non-health care and time costs are rarely collected, though the incorporation of such data is essential for performing cost-effectiveness analyses according to established guidelines.Objectives. To explore the challenges involved in collecting and analyzing these data from patients enrolled in a clinical trial.Methods. Through the use of a pilot study, the authors designed a questionnaire to collect these costs. They used this questionnaire in a clinical trial conducted at a comprehensive cancer center and a public community hospital. Patients in the trial were undergoing screening or diagnostic procedures through a clinical protocol designed to measure the effectiveness of fluorescence and reflectance spectroscopy for detecting cervical precancers. Direct non-health care costs were adjusted to 2003 constant dollars. Results. The authors successfully collected direct non-health care and time cost data, thus demonstrating the feasibility of acquiring such data. Compared to patients receiving diagnostic services for cervical cancer, those receiving screening services for the same condition in both settings incurred lower direct non-health care costs and time costs, as defined in the questionnaire. Compared to patients receiving either service at the comprehensive cancer center, those seeking either service at the public community hospital incurred lower direct non-health care costs and time costs. When outliers were removed, total direct non-health care costs and time costs substantially decreased for diagnostic patients in the comprehensive cancer center; total direct non-health care costs and time costs for other subgroups remained essentially unchanged. Conclusions. Direct non-health care and time cost data can be collected within a large-scale clinical trial. The setting (community v. specialty hospital) and population (patients receiving screening v. diagnostic examination) makes a difference regarding the cost totals. The order of magnitude of the final result depends on the context in which the non-health care and time cost data will be used.

Key Words: cervical cancer • costs and cost analysis • diagnosis • screening • time costs

Medical Decision Making, Vol. 26, No. 3, 265-272 (2006)
DOI: 10.1177/027298906288679


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