The association of health care contact days with economic measures in the CCTG LY.12 trial

Background Given the intensive resources required to conduct economic analyses in clinical trials, a key need is identifying scalable measures of costs. Contact days - days with health care contact outside the home - may represent such a practical measure. Methods We conducted a secondary analysis of a trial that evaluated two pre-transplant chemotherapy regimens for lymphoma. We used trial resource use and patient-reported data to calculate contact days, direct costs, and indirect costs such as lost productivity. We assessed the association between the number of contact days and cost outcomes using linear regression models and Pearson correlation coefficients. Results Contact days were moderately correlated with direct costs (r = .47, $762/ contact day, P < .0001), and strongly correlated with direct costs in the DHAP arm (r = 0.60, $727/ contact day, P < .0001). Contact days were very weakly correlated with pooled indirect costs (r 0.19, $60/ contact day, P = .0003). Among the 3 indirect cost outcomes, the relationship was strongest with paid caregiving hours (r = 0.33, 1.8 hours/ contact day, P < .0001) and weakest for unpaid hours provided by informal care partners (r = .06,. 7 hours/ contact day, P = .247). Results were robust when zeroing out costs of hospitalization in the arm receiving inpatient chemotherapy and when evaluating indirect costs among patients working full-time. Conclusions Contact days have the potential as a surrogate measure of direct health system costs, which deserves further exploration. The weak correlation with indirect cost outcomes suggests that the extent of true patient and care partner burdens extends beyond just the number of contact days.