Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects adolescent and minority women and puts the affected patient at risk for ectopic pregnancy, chronic pelvic pain, and infertility. The availability of effective oral antibiotic regimens and positive findings from an outpatient efficacy trial have resulted in a shift in our approach to treatment towards outpatient therapy. A recent cost-effectiveness analysis using the efficacy trial data and comparing management strategies supports this shift. The literature, however, has been relatively silent on how to effectively translate these findings to the care of the adolescent girl. If public health professionals and health providers for adolescents fail to consider the differential effects of trial participation on adolescent girls'adherence to therapy compared to adult women in the efficacy trial and the lack of published decision models tailored to the unique aspects of adolescence, the relevance of these studies to the management of adolescent girls will be limited. As a developing public health clinician-scientist, I have focused on improving PID care for adolescents. Although I have a MPH and have published 22 articles and chapters, I need additional public health training to take the next logical step in my line of research. The primary training aims of this career development project are to expand my ability to design, implement, and evaluate public health interventions using the tenets of decision-analysis and health economics, and to develop the capacity to incorporate consumer values into cost-benefit analyses of STI intervention programs.
The research aims are 1) to explore the care preferences, measures of cost, and acceptable alternatives for comprehensive and developmentally-appropriate care for adolescents with PID using contingent valuation methods(CVM);and 2) to create a cost-benefit model that incorporates adolescent-specific utilities to determine he thresholds for effectiveness that would be required for alternative interventions. Parents, adolescents, and clinicians will be recruited from high STI prevalence communities to participate in the CVM study. Using published adolescent-specific outcome parameters and the utilities defined by the CVM study, an economic decision model will be developed to empirically define a strategic approach to clinical management of the adolescent with PID. This work has the potential to clarify the results from adult efficacy trials and society-focused economic analyses, resulting in improved quality of care and health outcomes for adolescents affected by the disorder. It will also yield preliminary data on patient preferences that can lead to the design of alternative outpatient interventions that are less costly than inpatient therapy, but are acceptable to the consumers adolescent girls and their parents) and providers of PID clinical services.
