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Cynthia L. Chen, MD; Miriam Kuppermann, PhD, MPH; Aaron B. Caughey, MD, MPP, MPH; Lee T. Zane, MD, MAS

Arch Dermatol. 2008;144(8):988-994.

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.

Author Affiliations: School of Medicine (Dr Chen), Departments of Obstetrics, Gynecology, and Reproductive Sciences (Drs Kuppermann and Caughey), and Epidemiology and Biostatistics (Drs Kuppermann and Caughey), Dermatology (Dr Zane), and Medical Effectiveness Research Center for Diverse Populations (Dr Kuppermann), School of Medicine, University of California, San Francisco. Dr Chen is now with the Department of Dermatology at the University of California, San Francisco. Dr Zane is now with Anacor Pharmaceuticals Inc, Palo Alto, California.

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