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Hospitalization for pelvic inflammatory disease: a cost-effectiveness analysis
Kenneth J Smith1, Roberta B Ness, Mark S Roberts
1Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. smithkj2@upmc.edu
Sexually Transmitted Diseases
|June 24, 2006
Summary
Hospitalizing young women for pelvic inflammatory disease (PID) is generally not cost-effective. Even with improved complication rates, the expense per quality-adjusted life-year gained often remains high.
Area of Science:
- Reproductive Health
- Health Economics
- Clinical Decision Modeling
Background:
- Pelvic inflammatory disease (PID) frequently leads to hospitalization in nulliparous women.
- Adolescents and young women are particularly susceptible to PID and its complications.
Purpose of the Study:
- To assess the economic feasibility of inpatient treatment for PID in adolescents and young women.
- To compare the cost-effectiveness of hospitalization versus outpatient care for mild to moderate PID.
Main Methods:
- A Markov decision model was employed to analyze costs and outcomes.
- Cost-effectiveness was calculated as cost per quality-adjusted life-year (QALY) gained.
- The model incorporated varying assumptions on hospitalization's impact on PID complications and chronic pelvic pain.
Main Results:
- Hospitalization costs per QALY gained were $145,000, $67,400, and $42,400 if complications decreased by 10%, 20%, or 30%, respectively.
- The analysis was highly sensitive to assumptions regarding chronic pelvic pain development.
- Costs per QALY increased significantly if hospitalization did not mitigate chronic pain.
Conclusions:
- Hospitalization for PID in young women is unlikely to be economically justifiable for fertility preservation.
- Even substantial reductions in PID complications do not typically render hospitalization cost-effective.
- Outpatient management may be a more economically sound approach for mild to moderate PID.
