Patients' Preferences for Surgical Procedures in Hidradenitis Suppurativa: A Discrete Choice Experiment

Hidradenitis suppurativa is a burdensome chronic inflammatory skin disorder. While surgery can be essential for many patients, preferences and values regarding surgery are insufficiently characterized. This study aimed to investigate preferences of adult patients with hidradenitis suppurativa in the USA when choosing an hidradenitis suppurativa surgery method.

A discrete choice experiment was conducted. Patients were asked to choose between two hypothetical procedures 15 times. Literature review and patients with hidradenitis suppurativa and expert interviews informed treatment attributes selection. A mixed logit model was applied to estimate preference coefficients. Subgroup analyses and a latent class model were conducted.

Relevant attributes for the 205 participants (90% female, aged 41 years) ranked as follows: effectiveness on lesion improvement (36.75%), recurrence/persistence risk (15.02%), out-of-pocket costs (13.27%), post-surgical wound care (13.27%), post-surgical pain duration (9.64%), recovery time (7.12%) and complications risk (4.94%). A latent class model revealed participants in class 1 including more people of White/Caucasian, Asian and Latino ethnicity and full-time and part-time employed and non-working people put a higher value on risk of return and less priority on wound care post-surgery and out-of-pocket costs. For participants of class 2 consisting of more people of Black or other ethnicity and self-employed, students or retired people, the opposite was observed.

Of the evaluated attributes, effectiveness for improvement, recurrence risk, out-of-pocket costs and post-surgical wound care contributed most to patient preference. Surgeons should account for these aspects of procedures when offering surgical interventions. Studies of surgical outcomes should place high value on these aspects of procedural outcomes.