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

ABSTRACT 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 to 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 (ICER) 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 to standard care with 8.14 QALYs costing $20,492. The resulting ICER 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. Additionally, the nature of TECH-N lends itself to being coupled with other home-health/community strategies, which could further improve its value proposition.