BUDGET SHEET

Protocol Title: A single site, open non-randomized, exploratory clinical investigation to demonstrate early safety and effectiveness of the CLiKX tympanostomy tube applicator system.

Protocol No: CX-CDP-CIP-CLiKX(Beta) ver (to be confirmed)

PI:
Target Subject No: 15

Visit 3 Visit 4
Unit Cost Visit 1 Visit 2
Type of Expenditure (IDR) Screening surgery
2 week post- 2 months
op post-op
Total cost
Visit no 1 2 3 4 Remarks
SGD per item
Number of patients 15

A Direct Patient Costs

1 Clinic Consultation
1) Initial Visit 161000 15 2415000
2) Follow-up Visit 161000 15 15 4830000
2 Cost of patient assessments / procedural charges 1521000 15 22815000
1 Hearing test audiometry (for certain patients) 256000 15 15 7680000

2 Tympanogram 332000 15 15 9960000

3 Pre and Post-Operation Medications 5000000 15 15 15 225000000

Subtotal (A) 272700000

B Professional Fee
1 Study coordinator fee 15 30 15 15 0
2 Audiologist fee 15 15 15 0
Subtotal (B) 0

C Non Patient Costs

1 PI's Professional Fee 15 30 15 15 0

Subtotal (C) 0

D Pass Through Cost to Patient (No GST)

Transport allowance 15 15 15 15 0
Subtotal (D) 0

GRAND TOTAL (A + B + C + D) 272,700,000

GRAND TOTAL 272,700,000

Average per patient 18180000