Cost-Effectiveness Analysis of the Technology-Enhanced Community Health Nursing Program for Adolescent Girls and Young Adult Women With Pelvic Inflammatory Disease

Background: Pelvic inflammatory disease (PID) disproportionately impacts adolescents and young adult women. The Technology-Enhanced Community Health Nursing (TECH-N) trial demonstrated the potential benefit of a novel community health intervention for adolescents with PID. We assess the cost-effectiveness of TECH-N compared with standard care. Methods: We constructed a cohort Markov model to assess the cost-effectiveness of TECH-N for adolescents with PID in an urban setting. The model used nine health states: PID; two states for STIs; four states for PID sequelae, recovery, and deceased states. The cohort consisted of 18-year-old female adolescents with mild to moderate PID. Transition probabilities 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 and public databases. The model took a health system perspective over a 10-year time horizon. Sensitivity analyses were used to assess uncertainty. Cost-effectiveness was estimated using the discounted incremental cost-effectiveness ratio with effects measured in quality-adjusted life years (QALYs). Results: Over ten years, the TECH-N cohort generated 8.16 QALYs per individual at a cost of $20,419 compared with standard care with 8.14 QALYs costing $20,492. The resulting incremental cost-effectiveness ratio was negative since the intervention produced more QALYs at a lower cost; suggesting TECH-N is cost-saving. Conclusions: Our model suggests the TECH-N intervention yields better outcomes at lower overall costs. In addition, the nature of TECH-N lends itself to being coupled with other home-health/community strategies, which could further improve its value proposition.