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Infectious Diseases in Obstetrics and Gynecology
Volume 3, Issue 1, Pages 12-21
Clinical Study

Doxycycline or Ofloxacin for Outpatient Chlamydial Pelvic Inflammatory Disease? A Cost-Benefit and Cost-Effectiveness Analysis

1Health Decisions, Inc., 100 Europa Drive, Suite 525, Chapel Hill, NC 27515, USA
2Departments of Epidemiology and Obstetrics-Gynecology, University of North Carolina, Chapel Hill, NC, USA

Received 10 November 1994; Accepted 12 May 1995

Copyright © 1995 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: The current Centers for Disease Control and Prevention (CDC) guidelines include 2 drugs, doxycycline and ofloxacin, for treatment of the chlamydial component of outpatient pelvic inflammatory disease (PID). Although ofloxacin costs about $90 more than doxycycline, doxycycline is frequently associated with side effects and patient compliance with this drug is probably poor. Because clinicians have little information by which to judge the tradeoffs between price and compliance for these 2 antibiotics, we examined the impact of patient compliance in the evaluation of the costs and benefits of using each drug.

Methods: The incidence and direct costs of PID sequelae (infertility, ectopic pregnancy, and chronic pelvic pain) resulting after partially treated chlamydial PID were taken from previous estimates. For differing levels of antibiotic compliance, the probability of cure, probability of the occurrence of sequelae, and the associated cost of each were calculated. Because the relationship between partial antibiotic compliance and PID cure is unknown, we included 3 plausible relationships in our analyses. The sensitivity analysis was performed by varying key assumptions and examining the effect of each on future costs.

Results: The average probability of future PID sequelae attributable to chlamydia is slightly less than 2%, with an associated cost of $1,272. With an average compliance for doxycycline of 50%, an improvement in compliance of as little as 1.8–3.5 percentage points (51.8–53.5%), depending on the assumption used regarding partial compliance and cure, would make the use of ofloxacin less costly than doxycycline in the long run. Even with a cost difference of $90 between the 2 drugs, a 10-percentage-point increase in compliance (to 60% compliance) with the more expensive drug would save $2.63 for each $1.00 spent.

Conclusions: Since the long-term costs of PID are likely to overshadow the immediate cost of providing treatment, physicians should carefully consider the likelihood of patient compliance in selecting an antibiotic.