The Collection of Indirect and Nonmedical Direct Costs (COIN) form: a new tool for collecting the invisible costs of androgen independent prostate carcinoma.
BACKGROUND
There are limited data available regarding the cost of care in patients with androgen independent prostate carcinoma (AIPC), and there are no data on the impact of direct nonmedical and indirect costs (DNM/IC). This lack of data, along with the feasibility of collecting DNM/IC, was examined in patients with AIPC who took part in a randomized trial using a newly developed questionnaire, the Collection of Indirect and Nonmedical Direct Costs (COIN) form.


METHODS
Patients with AIPC were randomized to one of three treatment arms: 1) strontium only (strontium 4 Mci in Week 1 and Week 12) (STRONT); 2) vinblastine 4 mg/m(2) per week for 3 weeks then 1 week off and estramustine, 10 mg/kg per day (CHEMO); or 3) a combination of treatments outlined in the arms for CHEMO and STRONT (CHEMO/STRONT). Direct medical costs were collected through the hospital billing system. DNM/IC data were obtained prospectively using the COIN form. Cost data were analyzed for a period of 6 months.


RESULTS
Twenty-nine patients were randomized, after which the protocol was closed because of poor accrual. The median survival of the patients was 22.3 months. The mean and median total costs for the 20 of 29 patients with complete cost information were $12,647 and $11,257 over 6 months, respectively. DNM/IC represented 11% of the total cost (range, from < 1% to 42%); in 20% of participating individuals, these costs accounted for 35-42% of total costs. Failure to collect complete cost information was due to early death, administrative difficulties, and loss to follow-up.


CONCLUSIONS
In this pilot project, the collection of these cost data using the COIN form was feasible and practical and was limited primarily by logistic, not form specific, issues. DNM/IC were found to be a significant proportion of total costs (up to 42%) in selected patients, and this information proved to be a useful addition to the cost analysis. Approximately 98 patients would be required to detect a 20% difference in total costs between arms in a properly powered, randomized trial. Considering the potentially significant impact on total costs, DNM/IC data should be included in future cost-analysis studies of patients with AIPC and other diseases.
Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
E J
EJ
Sherman
D G
DG
Pfister
H S
HS
Ruchlin
D M
DM
Rubin
M H
MH
Radzyner
G H
GH
Kelleher
S F
SF
Slovin
W K
WK
Kelly
H I
HI
Scher
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000191:economics* / Q000556:secondary; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000556:secondary; D017281:Cost of Illness; D016527:Drug Costs; D004961:Estramustine / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D010865:Pilot Projects; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D013324:Strontium / Q000191:economics / Q000627:therapeutic use; D014747:Vinblastine / Q000191:economics / Q000627:therapeutic use
D000970:Antineoplastic Agents; D004961:Estramustine; D014747:Vinblastine; C025700:strontium chloride; D013324:Strontium