Cost-utility analysis of clinic-based deroofing versus local excision for hidradenitis suppurativa

Hundal, Sabrina, Cappelli, Julian, Croitoru, David, Drucker, Aaron M., Ingram, John R. ORCID: https://orcid.org/0000-0002-5257-1142, Goldberg, Stephanie R. and Netchiporouk, Elena 2024. Cost-utility analysis of clinic-based deroofing versus local excision for hidradenitis suppurativa. Journal of The American Academy of Dermatology 10.1016/j.jaad.2024.11.057

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Abstract

Background Deroofing and local excision are common clinic-based surgical options for hidradenitis suppurativa. Evidence suggests deroofing may have lower rates of adverse events (AEs), defined as disease recurrence or postsurgical complications. Objective This cost-utility analysis evaluates the economic and health-related impacts of clinic-based deroofing vs excision for hidradenitis suppurativa, comparing direct medical costs and quality-adjusted life-years (QALYs). Methods A Markov model was developed based on a literature review of clinical outcomes, EQ-5D utilities, and resource utilization. Patients began in a preprocedural state and transitioned monthly among 3 health states: responders (no AEs), nonresponders (≥1 AE), and death. The model assessed cost-effectiveness over a 2-year horizon from the U.S. healthcare system perspective. Results Deroofing provided an additional 0.19 QALYs at a cost of USD$311.39 per patient relative to excision, yielding a favorable incremental cost-effectiveness ratio of USD$1677.10/QALY, below the USD$50,000/QALY threshold. Limitations Methodological constraints from limited published data were addressed through multiple sensitivity analyses. Cost-effectiveness was sensitive to AE rates, secondary costs, and utility values. Conclusion When clinically appropriate, deroofing is more cost-effective than excision for clinic-based procedural management of HS, offering improved quality of life at a modest incremental cost.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Medicine
Publisher:	Elsevier
ISSN:	0190-9622
Date of First Compliant Deposit:	29 December 2024
Date of Acceptance:	8 December 2024
Last Modified:	08 Jan 2025 16:00
URI:	https://orca.cardiff.ac.uk/id/eprint/174920

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