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

Pelvic inflammatory Disease (PID) disproportionately impacts adolescent and young adult women with the risk of major reproductive health sequelae. 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 an urban setting. In this study, we assess the cost-effectiveness of such an intervention compared to standard care. 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 captures nine health states, including 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 death state. The cohort consisted of a hypothetical cohort of 18-year-old female adolescents with mild to moderate PID, with the cohort starting in the PID health state. Most 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 20-year time horizon using a health system perspective. Multivariate probabilistic sensitivity analysis and univariate sensitivity analysis were used to assess uncertainty. The key outcome of the analysis was the calculation of the incremental cost per quality-adjusted life year (QALY) between the TECH-N intervention group and the standard of care group. Over the course of 20 years, the intervention cohort generated 15.2 QALYs per individual at a cost of $7,724. The standard of care cohort generated 14.7 QALYs per individual at a cost of $5,243. The resulting ICER was $4,960 per QALY is well below a willingness to pay threshold of $100,000 per QALY. For the intervention arm, the increased cost is attributable to the cost of the TECH-N program. Part of the increased cost was offset by lower PID sequelae incidence, which typically contributes to the significant healthcare cost burden. The higher QALYs for intervention were driven by a lower incidence of PID and PID sequelae after the initial occurrence of PID. Sensitivity analysis identified the cost of the intervention and the relative rate of future PID to be the main drivers of the results. Our model suggests TECH-N is a cost-effective public health intervention that yields better outcomes at slightly higher 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.