ADOLESCENT AND PARENTAL UTILITIES FOR THE HEALTH STATES ASSOCIATED WITH PELVIC INFLAMMATORY DISEASE (PID)

Maria Trent, MD, MPH, Harold Lehmann, MD, PhD, Carol Thompson, MS, MBA, Qian Qiang, MD, MS Jonathan M. Ellen, MD, Kevin Frick, PhD

Johns Hopkins University School of Medicine & Bloomberg School Public Health, Baltimore, MarylandFunding: Centers for Disease Control and Prevention (K01 DP001128-02)

BACKGROUND

RESULTS

LIMITATIONS

CONCLUSIONSMETHODS

• Provides first estimates of health utility associated with PID among adolescents and the parents of adolescents

• Measures can be used in economic analyses assessing costs and preventable disease burden estimates

• These findings demonstrate that parents consistently underestimate the disutility adolescents attribute to all HRQL and 3 of 5 TTO assessments

• Adolescents are willing to give up more of their lives for health gains to prevent PID health states (1 year of life to prevent outpatient PID and ectopic pregnancy and 2 years to prevent PID requiring a hospitalization)

Contingent Valuation Study Overview

Data Analysis: Multiple linear (VAS) and quantile (TTO) regression analyses

PID OUTPATIENT TREATMENT

Imagine a 15-year-old girl with pelvic inflammatory disease who does not require a hospital stay for treatment. She will take antibiotic pills for 14 days to treat it. She will also need to notify her sexual partner, return to the clinic within 72 hours for care, and abstain from sexual intercourse

during treatment. She will have pain for about 7 days, with the pain mainly in the lower abdomen. It will interfere with daily activity, work, sleep, and family relations. Having sex is usually painful,

and fever, nausea, and vaginal discharge are often part of the illness. She will be able to eat and drink pretty much as usual.

She has a small chance of developing complications that could require a hospital stay and possibly an operation. Long-term problems with pain, difficulty with becoming pregnant, or with

tubal pregnancy could occur, even if she is treated. She will probably return to her usual health once the illness goes away, but will have an increased

chance of getting pelvic inflammatory disease again in the future.

If you had pelvic inflammatory disease (PID) NOT requiring a hospital stay, how would you rate your quality of life? (Click VAS Cartoon)

If you had 50 years to live after having pelvic inflammatory disease not requiring hospital treatment, how many years would you give up to live in perfect health?

Health utility assessment is a critical component of economic evaluation

Quantitatively assesses the preferences associated with a given health state

Economic analyses for PID resource allocation have been driven by adult patient preferences and outcomes

Limited information about how consumers of adolescent PID care value the health states associated with the disorder

Contact Information Maria Trent, MD, MPH

Associate Professor of PediatricsJohns Hopkins School of Medicine

200 N. Wolfe Street, #2064Baltimore, MD 21287443.287.8945 (office)

410.502.5440 (fax)mtrent2@jhmi.edu

OBJECTIVE

To determine and compare the adolescent and parent PID-related health utilities

Adolescent Girls 12-19 yrs

Pediatric, Adolescent,School Health clinical settings

Parents/Guardians (>18 yrs) Raised/Raising an AdolescentPediatric & Adolescent clinical

settings

Waiting Room recruitment & Provider referralWeb-Based Survey Elicitation

Survey Online Consent

Approved by the Johns Hopkins Medicine Institutional Review Board & the Baltimore City Health Department Research Review

Committee

Reviewed 5 Scenarios describing PID health states1. Outpatient treatment (15 year old, mild-moderate disease)2. Inpatient treatment (15 year old, moderate-severe disease)3. Ectopic Pregnancy (15 year old)4. Chronic Abdominal Pain (15 year old)5. Tubal Infertility (25 year old)

For each scenario:1. Rated Health Related Quality of Life using a Visual Analog

Scale (VAS) 2. Completed a Time Trade Off Assessment

• Respondents asked to trade months or years ofperfect health from a maximum of 50 future years of imperfect health due to PID

3. Perspective• Adolescents completed for themselves• Parents completed for “their daughter’s”

Selected Demographic Parents (N=121) Adolescents (N=134)

Mean Age (s.d.)

42.60 (9.96) 16.16 (1.74)

Gender

Female N (%) 108 (89.3) 134 (100)Race

Non-white 86 (72.3) 115 (87.1)Employed

Yes N (%) 92 (76.0) 31 (23.1)Annual Income

Median $ (IQR) 45000 (25000) 7800 (6123)Have children? (based on parity)

Yes N (%) 118 (97.5) 11 (8.2)

SAMPLE QUESTION

Health States

Mean VAS (SD) β (SEβ)

p Median TTO (IQR)

Coefficient (SE)

p

Adol Parent Adol Parent

Outpatient Treatment

62 (24.0)

76 (23.3)

-13.9 (3.1)

<.001 0.98 (0.12)

0.90 (0.02) 

-0.18 (.004)

<.001

Inpatient treatment

57 (25.1)

74 (23.1)

-18.1 (3.1)

<.001*

0.96 (0.16)

1.0 (0.04)

0.037 (.003)**

<.001*

Ectopic 55 (25.4)

73 (23.78)

-19.3 (3.2)

<.001*

0.98 (0.11)

1.0 (0.02)

-0.018 (.004)

<.001

Infertility 59 (23.6)

68 (27.1)

-12.0 (3.6)

.001*

0.98 (.07)

1.0 (0.03)

0 (.01) 1.0

Chronic Abdominal Pain

48 (25.4)

61 (23.8)

-13.5 (3.2)

<.001 0.98 (0.35)

0.98 (0.09)

0 (.001) 1.0

• Limited generalizability• Clinic-based samples from a single urban community with

high STI rates• Important due to health disparities associated with PID

• Unable to compare differences between affected and non-affected girls• Data represents community (societal) perspective• Preferred for economic analyses

IMPLICATIONS

• Consumers of adolescent PID services perceive significant disruption in HRQL when given the opportunity to evaluate potential outcomes

• Parents underestimate the strength of preferences in adolescent girls in a general community sample

• Future economic analyses using patient preferences for resource

allocation should include adolescent health utilities and outcomes