Background: Economic analyses have suggested that outpatient treatment is the most cost-effective strategy for pelvic inflammatory disease (PID) management; however, few studies have incorporated adolescent-specific parameters. In order to develop a strategic approach to adolescent care, additional assessments of costs are indicated.
Objectives: To determine the costs of PID care and factors that may contribute to higher costs among adolescents and young adults cared for in a large urban university based hospital system.
Methods: We used cross-sectional retrospective analysis of administrative billing data. ICD-9 coding was used to identify 172 adolescents, aged 12-21 years treated for PID as a primary diagnosis between May 1, 2008 and April 30, 2009. The dataset included demographics, location of care, admission status, and the total physician, diagnostic, and hospital-related charges. Differences were evaluated using linear regression.
Results: The mean age was 18.0 (SD 2.1) years. The majority was African American (90%), low income based on insurance status (78%), cared for in an emergency department (ED) setting (65.5%), and had one PID diagnosis during study period (89%). The average cost of PID care was $3162 (SD $4537). The average costs for patients seen in outpatient clinics was $ 930 (SD $1745), ED patients $1196 (SD $730), and inpatient units $9295 (SD $4538). Excluding adolescents treated for PID on inpatient psychiatric units (N=5), hospitalized adolescents generated PID charges that were $7718 (SE β $487 95% CI: $6757: $8679) higher than ambulatory (ED/clinic) units.
Conclusions: While treatment for PID is considerably lower in ambulatory settings, the charges are higher than anticipated based on inflation-adjusted comparison of published data and highly variable within a single hospital system.
Implications for Programs, Policy, and/or Research: Efforts to standardize care across units may reduce and stabilize costs for PID treatment. Additional research exploring cost in the context of quality of care and longitudinal outcomes is warranted.