Development of a modular resource-use measure for use in economic evaluations alongside randomised controlled trials

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Patient-reported resource-use measures (RUMs) are designed for capturing resource-use data in economic evaluations of healthcare. RUMs are commonly developed on a trial-by-trial basis, with validation rarely performed. There does not currently exist a concise, generic RUM that is well-utilised in trial-based economic evaluations. The aim of this thesis was to develop the healthcare module of a new standardised, generic modular RUM (ModRUM) from items previously identified in a Delphi survey, and test the validity, acceptability, and feasibility of ModRUM.

In a review of existing RUMs, the reporting of the development and psychometric assessment of RUMs was found to be rare. The initial prototype of ModRUM was constructed from items identified in the Delphi study, with reference to existing RUMs and in consultation with experienced health economists and patient-reported outcome measure developers.

The measurement properties of ModRUM were tested in four evaluation studies, with modifications made within and between studies. The first study involved qualitative interviews with health economists to test content and face validity and assess whether questions were suitable for costing purposes in economic evaluations. The second study encompassed qualitative ‘think aloud’ interviews including retrospective probing with patients recruited from primary care, to assess content validity and acceptability. In the third study, a user guide was developed, and health economists piloted the adaptation process in recently funded trials. They also provided feedback in an online survey on the feasibility of using ModRUM for resource-use data collection. The fourth quantitative study involved piloting ModRUM with patients recruited from primary care to assess feasibility, acceptability, and construct and criterion validity.

This thesis has provided preliminary evidence for the validity, acceptability, and feasibility of ModRUM. Further testing is required within randomised controlled trials. Future development should include increasing the breadth of ModRUM, to cover sectors beyond healthcare.
Date of Award12 May 2022
Original languageEnglish
Awarding Institution
  • University of Bristol
SponsorsMRC HTMR
SupervisorSamantha K Husbands (Supervisor), Sian M Noble (Supervisor), Joanna C Thorn (Supervisor) & William Hollingworth (Supervisor)

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