Comparative Cost Effectiveness Analysis of Empirical and Non-empirical Therapy in Pelvic Inflammatory Disease in a Tertiary Health Institution, North-central Nigeria

Abstract

Abstract
Background: Pelvic inflammatory disease (PID) is a leading cause of infertility, ectopic pregnancies and psychological trauma, thus, representing a major public health concern and high economic burden for women in their reproductive ages.As a result, it will be beneficial to identify competing options in drug therapy in order to redirect resources with the aim of achieving more value for money in terms of cost effectiveness.
Objective: To conduct a comparative cost-effectiveness analysis of empirical and non-empirical therapy in Pelvic Inflammatory Diseases among patients attending the General out-patient clinic and Gynecology clinic in University of Ilorin Teaching Hospital, North central Nigeria.
Methods: After including a 10% attrition rate, a sample size of 369case notes was derived from a total population of 2, 652 PID patients. A drug utilization study was conducted through a one year retrospective review (January 2021 to December 2021) of the 369 case notes The case notes were selected by systematic random sampling using sampling interval of 5. This was accompanied by using the World Health Organization-defined daily dose method of evaluating
drug use. EQ-5D-5L was employed in determining the effectiveness of the identified treatment options in terms of quality adjusted life years (QALYs).
Results: One hundred and four of the selected cases (28%) were not tested for PID and were placed on empirical therapy while 265 (72%) were tested and benefited from targeted therapy or non-empirical therapy. The overall Mean Effectiveness obtained expressed as quality adjusted life years (QALY) was 0.578. The overall Mean utility status obtained from the EQ VAS was 74.52. The total cost obtained to access empirical therapy was N5,880(14USD) with an effectiveness of 0.637 while the total cost obtained to access non-empirical therapy was N8,715 (21USD) with an effectiveness of 0.555.
In conclusion there was statistically significant difference (P=0.007) in the effectiveness/outcome of Empirical compared with Non-empirical regimen, with Empirical regimen being more effective and also more cost-effective.