Hospitalization for Pelvic Inflammatory Disease: A Cost-Effectiveness Analysis

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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, $67,400, or $42,400, 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.

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