Hospitalization for pelvic inflammatory disease: a cost-effectiveness analysis.

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.