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Hospitalization for Pelvic Inflammatory Disease: A Cost-Effectiveness Analysis

Smith, Kenneth J. MD, MSc*; Ness, Roberta B. MD, MPH; Roberts, Mark S. MD, MPP*

doi: 10.1097/01.olq.0000225321.61049.13

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.

Routinely hospitalizing young women and adolescents for pelvic inflammatory disease is unlikely to be economically reasonable, even if substantial improvements in complication rates are assumed.

From the *Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the †Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania

This study was supported by NIAID grant K23 AI056347.

Correspondence: Kenneth J. Smith, MD, MSc, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213. E-mail:

Received for publication March 6, 2006, and accepted April 24, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association