Cost-Effectiveness of the Technology-Enhanced Community Health Nursing Intervention for Adolescents and Young Adults with Pelvic Inflammatory Disease

Background

Pelvic inflammatory Disease (PID) disproportionately impacts adolescent and young adult women. The Technology-Enhanced Community Health Nursing (TECH-N) trial demonstrated the potential benefit of a novel community health nursing intervention for female adolescents with PID. In this study, we assess the cost-effectiveness of such an intervention compared to standard care.



Methods

We constructed a cohort Markov model to assess the cost-effectiveness of the TECH-N intervention for adolescents with PID in an urban setting. The model used nine health states: PID, two states for STIs (Chlamydia trachomatis and Neisseria gonorrhoeae), four states for PID sequelae (infertility, chronic pelvic pain, tubo-ovarian abscess, and ectopic pregnancy), a recovery state, and a deceased state. The cohort consisted of hypothetical 18-year-old female adolescents with mild to moderate PID. Transition probabilities between health states were derived from the TECH-N clinical trial and published literature. Health state utilities were derived from published literature. Intervention costs were estimated using TECH-N data, and health state costs were derived from published literature. Cost-effectiveness was assessed over a 10-year time horizon using a health system perspective. Sensitivity analyses were used to assess uncertainty. Cost-effectiveness was assessed using the the incremental cost per quality-adjusted life year (QALY).



Results

Over 10 years, the intervention cohort generated 9.6 QALYs per individual at a cost of $11,091 compared to 9.5 QALYs per individual at a cost of $11,857 for standard of care. The resulting ICER was negative, since the intervention produced better effects at a lower cost. The cost-saving results was driven by the low cost of the intervention and the reduced risk of STI’s and subsequent PID which resulted in lower downstream healthcare costs. Sensitivity analyses identified the cost of the intervention and the relative rate of future PID to be the main drivers of the results.



Conclusion

Our model suggests TECH-N is a cost saving public health intervention that yields better outcomes at lower overall costs. In addition, the nature of TECH-N intervention lends itself to be coupled with other home-health /community engagement strategies, which should reduce the operating cost of the intervention and further improve its value proposition.