Acne just seems to never go away for many adolescents. A new study published in the August issue of Archives of Dermatology reports results of a teen survey and finds that teens would pay about $275 to have never had acne. Researchers also found that adolescents said that they would be willing to pay more be free of acne than to have half of their acne cleared or to have clear skin with acne scars.
More formally known as acne vulgaris, the skin disorder impacts almost all adolescents and is often a factor that leads to anxiety, depression, embarrassment and social dysfunction. Cynthia L. Chen, M.D. (University of California, San Francisco) and colleagues write that, “Reducing the psychosocial impact of acne is considered one of the guiding principles for its clinical management and it is important to measure and evaluate this impact.”
Results from this study come from an analysis of 266 teen volunteers with acne from four public high schools in San Francisco. Chen and colleagues administered written surveys to the students that asked them to answer hypothetical questions such as how much of their lifetime they would forgo or how much money they would pay:
- To have never had acne,
- To be 100-percent acne-free from then on,
- To have 100-percent acne clearance but with visible scarring, or
- To have 50-percent acne clearance.
The survey also included questions for parents regarding their acne history and severity. Since parents usually pay for children’s acne treatments, they were also asked about their willingness to pay.
With the teens’ responses to the time trade-off questions, the researchers calculated current acne state utility scores by dividing the participants’ reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average utility score for a teen in his or her current acne state was 0.961. Scores improved to 0.978 for 100% clearance, 0.967 for 50% clearance, and 0.965 for 100% clearance but with scarring.
The median price that teens were willing to pay to have never had acne was $275. For 100% clearance of acne, they were willing to pay $100. The median price of 50% clearance would be $10, and of 100% clearance with scarring would be zero dollars. Parents had somewhat similar responses to the willingness-to-pay analysis, indicating a median of $250 for their child to never have had acne, $100 for 100%, $100 for 50%, and zero dollars for 100% clearance with scarring.
As expected, teens who believe their acne is more severe are willing to trade more time and money for acne clearance than those who rate their acne as less severe.
“Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients’ expectations of therapy,” write the authors. “Randomized, blinded, placebo-controlled trials have shown that three to four months of conventional acne therapy, including topical benzoyl peroxide, topical retinoids and oral antibiotics, typically produces reductions in lesion counts in the 40 percent to 60 percent range.”
They add that, “It has also been suggested that the incidence of scarring from facial acne approaches 95 percent…Thus, adolescents’ marked preference for total clearance over partial (50 percent) clearance or clearance with scarring suggests that physicians must weigh high patient expectations against these clinical data regarding efficacy and risk of sequelae.”
In an accompanying editorial, written by Marta J. VanBeek, M.D., M.P.H. (University of Iowa Hospitals and Clinics), “Dermatologists are keenly aware of the ways skin diseases may have a substantial impact on a patient’s overall quality of life. However, in an environment in which health expenditures are allocated by non-physicians, it is critical to demonstrate the burden of skin disease relative to non-dermatologic disease to funding sources, government agencies and the lay public.”
“In terms of social value, preference-weighted questionnaires are instrumental in evaluating the extent to which increased health care expenditures lead to patient benefits because they incorporate a summary description of health status, social values and life expectancy,” concludes Dr. VanBeek. “Fundamentally, utilities measure true patient preferences, uninhibited by physician assumptions. Such measurement refocuses physicians on the primary goal of our profession: improving the care of our patients.”
A Community-Based Study of Acne-Related Health Preferences in Adolescents
Cynthia L. Chen, MD; Miriam Kuppermann, PhD, MPH; Aaron B. Caughey, MD, MPP, MPH; Lee T. Zane, MD, MAS
Archives of Dermatology (2008). 144[8]: pp. 988-994.
Written by: Peter M Crosta