Mr/Ms/Mrs ……………………… APPENDIX 1.- STUDY BUDGET PROTOCOL CODE: STUDY TITLE: SUMMARY OF THE STUDY BUDGET ▪ ESTIMATED NUMBER OF PATIENTS TO RECRUIT PAYMENT COMPLETE AND EVALUABLE PATIENT € TOTAL COST OF STUDY € BREAKDOWN FOR VISITS ▪ TOTAL WITHOUT NUMBER OF COST PER DESCRIPTION EXTRAORDINARY VISITS VISIT COSTS Screening Visit Baseline Visit Treatment Visit Follow-up Visit Final Visit Screening Failure Visit/ Others TOTAL COST PER € € SUBJECT
Mr/Ms/Mrs ……………………… APPENDIX 1.- STUDY BUDGET PROTOCOL CODE: STUDY TITLE: ▪ SUMMARY OF THE STUDY BUDGET ESTIMATED NUMBER OF PATIENTS TO RECRUIT PAYMENT COMPLETE AND EVALUABLE PATIENT € TOTAL COST OF STUDY € ▪ BREAKDOWN FOR VISITS DESCRIPTION NUMBER OF VISITS COST PER VISIT TOTAL WITHOUT EXTRAORDINARY COSTS Screening Visit Baseline Visit Treatment Visit Follow-up Visit Final Visit Screening Failure Visit/ Others TOTAL COST PER SUBJECT € €
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