A community-based study of acne-related health preferences in adolescents

Objective: To examine preferences for acne-related outcomes in adolescents. Design: Community-based, cross-sectional survey study. Setting: Four public high schools in San Francisco, California. Participants: Volunteer sample of 266 adolescents with acne. Main Outcome Measures: Health utilities for current acne state and 3 hypothetical acne-related states (100% clearance, 50% clearance, and 100% clearance but with residual scarring) using time trade-off (TTO) and willingness to pay metrics. A self-administered written survey was used. Results: The mean (median) utilities for current acne state using the TTO metric was 0.961 (0.985). One hundred percent acne clearance received a higher utility score (mean [median] score, 0.978 [0.994]) than 50% clearance (0.967 [0.992]; P<.001 by Wilcoxon signed rank test) and 100% clearance with scarring (0.965 [0.992]; P<.001). Although current acne state utility was not correlated with physician-rated severity (P=.23), a significant association with subject-rated severity was observed in both univariate analysis (P=.01) and after adjustment for duration of acne, having seen a physician for acne, and income (P=.05). Adolescents were willing to pay a median of $275 to have never had acne in their lifetime and were willing to pay significantly more for 100% clearance than for 50% clearance or 100% clearance but with scarring (P<.001 for both comparisons). Conclusions: We describe adolescents' acne-related health state utilities. Compared with current acne state utility, both partial and total clearance with scarring are substantially less preferable than total clearance. Subjects' self-rated disease severity correlates with current acne state utility, whereas physician-rated severity does not. A self-administered paper instrument can effectively assess adolescents' acne-related preferences in community-based samples.