P50 How Much Does Adolescnt PID Care Really Cost? A within-System Analysis

Wednesday, March 10, 2010
Pre-Function Lobby & Grand Ballroom D2/E (M4) (Omni Hotel)
Maria Trent, MD, MPH, Pediatrics/Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD and Jonathan Ellen, MD, School of Medicine Ped Bay Bayview Pediatric Unit, The Johns Hopkins University, Baltimore, MD

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.

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