Skip to main content Accessibility help

Self-reports of health-care utilization: Diary or questionnaire?

  • Mandy van den Brink (a1), Wilbert B. van den Hout (a1), Anne M. Stiggelbout (a1), Hein Putter (a1), Cornelis J. H. van de Velde (a1) and Job Kievit (a1)...


Objectives: The feasibility and convergent validity of a cost diary and a cost questionnaire was investigated.

Methods: Data were obtained as part of a cost-utility analysis alongside a multicenter clinical trial in patients with resectable rectal cancer. A sample of 107 patients from 30 hospitals was asked to keep a weekly diary during the first 3 months after surgery, and a monthly diary from 3 to 12 months after surgery. A second sample of seventy-two patients from twenty-eight hospitals in the trial received a questionnaire at 3, 6, and 12 months after surgery, referring to the previous 3 or 6 months. Format and items of the questions were similar and included a wide range of medical and nonmedical items and costs after hospitalization for surgery.

Results: Small differences were found with respect to nonresponse (range, 79 to 86 percent) and missing questions (range, 1 to 6 percent between the diary and questionnaire). For most estimates of volumes of care and of costs, the diary and questionnaire did not differ significantly. Total 3-month nonhospital costs were €1,860, €1,280, and €1,050 in the diary sample and €1,860, €1,090, and €840 in the questionnaire sample at 3, 6, and 12 months after surgery, respectively (p =.50). However, with respect to open questions, the diary sample tended to report significantly more care.

Conclusions: For the assessment of health-care utilization in economic evaluations alongside clinical trials, a cost questionnaire with structured closed questions may replace a cost diary for recall periods up to 6 months.



Hide All
Barber JA, Thompson SG. 1998 Analysis and interpretation of cost data in randomized controlled trials: Review of published studies. BMJ. 317: 11951200.
Biemer PP, Groves RM, Lyberg LE, et al. 1991. Measurement errors in surveys. New York: John Wiley & Sons;
van den Brink M, van den Hout WB, Stiggelbout AM, et al. 2004 Cost-utility analysis of pre-operative radiotherapy in patients with rectal cancer undergoing total mesorectal excision. J Clin Oncol. 22: 244253.
van Campen C, Sixma H, Kerssens JJ, et al. 1998 Comparisons of the costs and quality of patient data collection by mail versus telephone versus in-person interviews. Eur J Public Health. 8: 6670.
Carsjo K, Thorslund M, Warneryd B. 1994 The validity of survey data on utilization of health and social services among the very old. J Gerontol. 49: S156S164.
Cleary PD, Jette AM. 1984 The validity of self-reported physician utilization measures. Med Care. 22: 796803.
Gold MR, Siegel JE, Russell LB, et al. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press;
Coughlin SS. 1990 Recall bias in epidemiologic studies. J Clin Epidemiol. 43: 8791.
Goossens ME, Rutten-van Molken MP, Vlaeyen JW, et al. 2000 The cost diary: A method to measure direct and indirect costs in costeffectiveness research. J Clin Epidemiol. 53: 688695.
Green S, Kaufert J, Corkhill R, et al. 1979 The collection of service utilisation data: A research note on validity. Soc Sci Med. 13A: 231234.
Hebert R, Bravo G, Korner-Bitensky N, et al. 1996 Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects. J Clin Epidemiol. 49: 373381.
van den Hout WB, van den Brink M, Stiggelbout AM, et al. 2002 Cost-effectiveness analysis of colorectal cancer treatments. Eur J Cancer. 38: 953963.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. 2001 Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 345: 638646.
Lippman A, Mackenzie SG. 1985 What is “recall bias” and does it exist? Prog Clin Biol Res. 163C: 205209.
Oostenbrink JB, Koopmanschap MA, Rutten FFH. 2000. Manual for cost analyzes, methods and standard prices for economic evaluations in health care (In Dutch). Amstelveen: Dutch Health Insurance Executive Board;
Perkins JJ, Sanson-Fisher RW. 1998 An examination of self- and telephone-administered modes of administration for the Australian SF-36. J Clin Epidemiol. 51: 969973.
Ross MM, Rideout EM, Carson MM. 1994 The use of the diary as a data collection technique. West J Nurs Res. 16: 414425.
Stone AA, Shiffman S, Schwartz JE. 2002 Patient non-compliance with paper diaries. BMJ. 324: 11931194.
Stone PW, Chapman RH, Sandberg EA, et al. 2000 Measuring costs in cost-utility analyzes. Variations in the literature. Int J Technol Assess Health Care. 16: 111124.
Wallihan DB, Stump TE, Callahan CM. 1999 Accuracy of self-reported health services use and patterns of care among urban older adults. Med Care. 37: 662670.
Weinberger M, Nagle B, Hanlon JT, et al. 1994 Assessing health-related quality of life in elderly outpatients: Telephone versus face-to-face administration. J Am Geriatr Soc. 42: 12951299.
van Wijck EE, Bosch JL, Hunink MGM. 1998 Time-tradeoff values and standard-gamble utilities assessed during telephone interviews versus face-to-face interviews. Med Decis Making. 18: 400405.
Wilson K, Roe B, Wright L. 1998 Telephone or face-to-face interviews?: A decision made on the basis of a pilot study. Int J Nurs Stud. 35: 314321.
Wu AW, Jacobson DL, Berzon RA, et al. 1997 The effect of mode of administration on medical outcomes study health ratings and EuroQol scores in AIDS. Qual Life Res. 6: 310.


Related content

Powered by UNSILO

Self-reports of health-care utilization: Diary or questionnaire?

  • Mandy van den Brink (a1), Wilbert B. van den Hout (a1), Anne M. Stiggelbout (a1), Hein Putter (a1), Cornelis J. H. van de Velde (a1) and Job Kievit (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.