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

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.