Study outlines teens' preferences and trade-offs for freedom from acne

August 18, 2008

Teens report that they would pay about $275 to have never had acne, and are willing to pay considerably more to be acne-free than to have 50 percent clearance of their acne or to have clear skin with acne scars, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

Acne vulgaris affects almost all adolescents and has been associated with anxiety, depression, embarrassment and social dysfunction, according to background information in the article. "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," the authors write.

Cynthia L. Chen, M.D., and colleagues at the University of California, San Francisco, studied 266 teen volunteers with acne from four public high schools in San Francisco. The participants completed written surveys regarding how much of their lifetime they would give up 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. They and their parents also were asked about acne history and severity, and parents were asked about their willingness to pay since they typically bear the cost of their children's acne treatment.

The researchers' used teens' responses to the time trade-off question to calculate their current acne state utility score. This was done by dividing the participants' reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average score for the current acne state was 0.961; 100-percent clearance received a higher score (0.978) than 50-percent clearance (0.967) and 100-percent clearance with scarring (0.965).

On the willingness-to-pay analysis, the teens reported they would pay a median (midpoint) of $275 to have never had acne, $100 to be 100-percent cleared of acne, $10 for 50-percent clearance and zero for 100-percent clearance with scarring. Parents said they would pay a median of $250 for their child to never have had acne, $100 for 100-percent clearance, $100 for 50-percent clearance and zero for 100-percent clearance with scarring.

Adolescents who rated their acne as more severe reported a willingness to trade more time and money for acne clearance than those with less severe acne.

"Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients' expectations of therapy," the authors write. "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."

"It has also been suggested that the incidence of scarring from facial acne approaches 95 percent," they continue. "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."

(Arch Dermatol. 2008;144[8]:988-994. Available pre-embargo to the media at

Editor's Note: Dr. Zane has participated on advisory boards for Connetics Corp., Stiefel Laboratories Inc., Medicis Pharmaceutical Corp. and QLT Inc., and is now an employee of Anacor Pharmaceuticals Inc. This study was supported in part by the Mount Zion Health Fund of the Jewish Community Endowment Fund. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Preference-Based Utility Questionnaires Help Improve Patient Care

"Dermatologists are keenly aware of the ways skin diseases may have a substantial impact on a patient's overall quality of life," writes Marta J. VanBeek, M.D., M.P.H., of the University of Iowa Hospitals and Clinics, in an accompanying editorial. "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," Dr. VanBeek writes. "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."

(Arch Dermatol. 2008;144[8]:1037-1041. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail

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