Validated Tools to Measure Costs for Patients: A Systematic Review

Development of an Online Dance Injury Surveillance System (ODISS): A Delphi Consensus, Usability, and Feasibility Study

OBJECTIVES

To develop an optimal outline for an online dance injury surveillance system (ODISS) based on expert consensus from a Delphi survey and evaluate the system's usability and feasibility within a fictional folk-dance academy setting.

BACKGROUND

Dance is characterized by intensive training and performance, which can elevate susceptibility to injuries. Robust surveillance systems are required to understand and mitigate this injury risk. Current systems exhibit limitations and lack uniformity.

METHODS

A Delphi panel of 35 stage 1 experts were recruited through snowball sampling from online professional networks, professional dance associations, organizations, and academies. Inclusion criteria were ≥18 years of age, fluent in English, and worked as dance academics or researchers, clinicians, instructors, managers, or competitive or professional dancers. These stage 1 experts were provided with a preliminary outline of a dance injury surveillance system that covered 6 domains: dancer demographics and screening, exposure monitoring, injury identification and classification, injury management, dancer recovery and system access. Stage 1 experts then voted on the importance of and provided feedback on different design elements within each domain across 2 Delphi survey rounds to determine a consensus system design outline. A pilot system was then developed and evaluated by stage 2 experts, who were end-users and included dance instructors and administrators from various dance academies/institutions recruited through direct invitations. These stage 2 experts utilized the System Usability Scale (SUS) and System Feasibility Measure (SFM) based on application to a fictional folk-dance injury scenario.

RESULTS

In survey round 1, the stage 1 experts reached consensus to include 30 elements and exclude 3 elements and demonstrated mixed opinion on 30 elements that were revised into 14 elements for further consideration in round 2. All but 1 element reached consensus to include after round 2. System testing demonstrated low marginal usability (SUS score: 58.2% ± 11.6%). Stage 2 experts agreed or strongly agreed the system was feasible for 86.7% ± 10.3% of SFM statement ratings. Key areas for improvement identified from stage 2 expert feedback were a need for an improved user interface and strategies to reduce data entry time burdens. A common suggestion was to integrate more dropdown and checkbox response options within the interface to increase efficiency of data entry.

CONCLUSION

This study established a Delphi-consensus on the essential design elements for an ODISS. Expert evaluation resulted in a usable and feasible online system that can be used to improve future dance injury surveillance research across dance populations.Level of EvidenceThe usability and feasibility portion of the study falls under Level 3 evidence according to the Centre for Evidence-Based Medicine (CEBM) hierarchy. Whereas the Delphi portion of the study is at Level 5 Evidence on the CEBM hierarchy.

Validation of the PECUNIA reference unit costs templates in Spain: a useful tool for multi-national economic evaluations of health technologies

BACKGROUND

The PECUNIA Project was funded by the H2020 programme in which 10 partners from six countries participated. The aim was to develop standardized, harmonized and validated methods and tools to calculate costs in different sectors (such as health and social care, education among others), with the purpose of facilitating comparability of economic evaluations of health technologies across European countries. In this paper we report the first validation of the developed reference unit cost templates in Spain.

METHODS

The evaluation of the PECUNIA Reference Unit Cost (RUC) Templates involved usability, transferability and feasibility assessment. Applicability tests were performed to estimate the cost of a selection of 15 resource items by means of the RUC templates in Spain and in four Spanish regions. External validation involved comparison with existing unit costs.

RESULTS

It was possible to estimate the cost of five services (dental care and general practitioner in the Canary Islands, general practitioner in Spain [tariffs], health-related day care centre and education services provided in a special education school in the Basque Country), car vandalism as an example of potential health-related consequences, and informal care in Spain. The templates were feasible although data completeness depended on the type of data needed to estimate the costs. The templates are transferable across countries although comparability depends on the services available in each jurisdiction.

CONCLUSIONS

The PECUNIA RUC Templates are free and feasible tools to estimate comparable reference unit costs across countries. Although more validation exercises are needed, they seem useful tools to perform robust multi-national economic evaluations and increase the transferability of cost-effectiveness studies of health technologies in Europe. However, they cannot compensate for the lack of data across jurisdictions.

Cost Analysis of a Patient Portal Used to Remotely Monitor COVID-19 Patients in Quebec

BACKGROUND

Telemonitoring for COVID-19 has gained much attention due to its potential in reducing morbidity, healthcare utilization, and costs. However, its benefit with regard to economic outcomes has yet to be clearly demonstrated.

OBJECTIVE

To analyze the costs associated with the use of the Opal portal to monitor COVID-19 patients during their 14-day confinement in Quebec and compare them to those of non-users of any home telemonitoring technology.

METHODS

A cost analysis was conducted through a cross-sectional study between COVID-19 patients who used (PU) the Opal platform during their 14-day confinement at home and those who did not use (PNU) any home remote monitoring technology. Data was collected between June 2021 to April 2022. An individual interview with each participant using an adapted questionnaire was conducted by telephone or online using a teleconferencing platform. A micro-costing approach was undertaken using a dual patient and Quebec's health-care system perspective.

RESULTS

27 telemonitoring participants, 29 non-users, 8 clinicians, and 4 managers were included. Telemonitoring reduced the average total costs incurred by PU by 82% ($537.3CAD) between PU ($117.2CAD) and PNU ($654.5CAD). Telemonitoring enrollees used healthcare less intensely with fewer emergency room visits (1 PU compared to 6 PNU), which translated to an average savings of $253.3CAD per patient.

CONCLUSION

This is the first study to demonstrate that telemonitoring through the Opal platform is a viable strategy to reduce healthcare costs and utilization for patients and the healthcare system. The evidence provides strong support for introducing telemonitoring as a component of case management.