1. 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, Maryland Funding: Centers for Disease Control and Prevention (K01 DP001128-02) BACKGROUND RESULTS LIMITATIONS CONCLUSIONS METHODS 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 Pediatrics Johns Hopkins School of Medicine 200 N. Wolfe Street, #2064 Baltimore, MD 21287 443.287.8945 (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 Adolescent Pediatric & Adolescent clinical settings Waiting Room recruitment & Provider referral Web-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 states 1.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 of perfect 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 DemographicParents (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) Coeffici ent (SE) p AdolParentAdolParent 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) <.0010.98 (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