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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
Insights
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.
Objective:
Nulliparous women are frequently hospitalized for treatment of pelvic inflammatory disease (PID).
Goal:
The goal of this study was to determine the economic feasibility of hospitalizing adolescents and young women for PID.
Study Design:
The authors conducted a Markov decision model, estimating the cost-effectiveness of hospitalization compared with outpatient therapy for mild to moderate PID for adolescents and young women, calculating costs per quality-adjusted life-year (QALY) gained under various assumptions about hospitalization effects on complications.
Results:
If hospitalization decreases PID complications by 10%, 20%, or 30%, the cost/QALY gained is 145,000 dollars, 67,400 dollars, or 42,400 dollars, respectively, compared with outpatient therapy. Assumptions about hospitalization effects on the development of chronic pelvic pain heavily weight the analysis; costs/QALY gained by hospitalization increase considerably if chronic pain is unaffected.
Conclusion:
Hospitalization for PID treatment to possibly preserve fertility in nulliparous young women and adolescents is unlikely to be economically reasonable even if substantial improvements in PID complication rates are assumed.
