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Association Between Willingness to Pay and Quality of Life in Acne Patients: A Cross-Sectional Study with a Nomogram
Xiangzi Li1, Xintao Cen1, Ning Ning1
1Shenzhen Institute of Dermatology, Shenzhen Dermatology Hospital, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, People's Republic of China.
Purpose:
To examine willingness to pay (WTP) for acne treatment and its associated factors, to assess the relationship between WTP and dermatology-specific quality of life as measured by the Dermatology Life Quality Index (DLQI), and to develop and internally validate a nomogram for predicting high WTP, with the aim of supporting individualized acne management and informed healthcare resource allocation.
Methods:
Patients with acne completed an electronic questionnaire assessing their WTP for a hypothetical one-time curative treatment, along with demographic, clinical, and DLQI data. High WTP was defined as >4000 CNY. Multivariable logistic regression identified factors associated with high WTP, and restricted cubic spline analysis explored the relationship between WTP and DLQI scores. The dataset was randomly divided into training (70%) and testing (30%) cohorts. LASSO regression was used to identify key predictors of WTP. The variables retained by LASSO were subsequently entered into a multivariate logistic regression prediction model, and the independent predictors were incorporated into a nomogram to estimate the probability of high WTP for each patient.
Results:
A total of 456 patients were included. Multivariate logistic regression analysis revealed that female sex, aged ≥25 years, monthly income ≥5000 CNY, moderate or severe acne, prior treatment history (medications, chemical peels, or combination therapies), recurrent acne, and annual acne-related expenditure >1000 CNY were significantly associated with high WTP. DLQI showed a linear relationship with WTP (Poverall = 0.04, P nonlinear = 0.77). Eight independent predictors identified from multivariable analyses were incorporated into the predictive nomogram, which showed good calibration and discrimination (AUC_train = 0.80; AUC_test = 0.77). Decision-curve analysis indicated clinical utility across threshold probabilities between 0.19 and 0.94.
Conclusion:
Patients' WTP for acne treatment reflects disease burden and quality-of-life impairment. A nomogram developed and validated in this study provides an effective tool for estimating WTP in acne patients and may support clinical decision-making and health-economic assessment.
