Financial Toxicity Independently Predicts QOL in Hidradenitis Suppurativa

Financial strain is an independent predictor of quality of life (QOL) for patients with hidradenitis suppurativa (HS), with greater disease burden, psychiatric comorbidities, and biologic use all associated with worsening financial hardship, according to a cross-sectional survey study published in the International Journal of Dermatology.¹

How Does Financial Toxicity Impact Quality of Life in HS?

Researchers at the University of Virginia used the Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) and the Dermatology Life Quality Index (DLQI) to survey 114 patients receiving HS care at an academic specialty clinic between April 2024 and January 2025.

The cohort skewed heavily female (72.8%), with a mean age of 36.9 years and diverse racial representation (49.1% White, 40.4% Black, and 10.5% other). Most patients had Hurley stage II (40.4%) or stage III (39.5%) disease, which reflects a high overall disease burden. Nearly two-thirds (64.0%) of patients had lesions at 3 or more anatomic sites.

The mean COST-FACIT score was 20.3, consistent with mild financial toxicity across the group, while the mean DLQI score of 14.4 indicated severe quality-of-life impairment. In multivariable regression analysis, each 1-point increase in COST-FACIT corresponded to a 0.448-point decrease in DLQI score, a statistically significant relationship (P < .001) that held after adjusting for age, sex, race, marital status, and employment status.

Who Faces the Greatest Financial Strain in HS?

Not all patients experienced financial toxicity equally. Psychiatric disease, tobacco use, greater anatomic disease involvement, and biologic use were each independently associated with lower COST-FACIT scores, or greater financial hardship. Patients with cardiovascular comorbidities also showed worse financial toxicity (P = .031). Each additional HS anatomic site was independently tied to worse financial strain, consistent with prior literature on the cumulative cost burden of more extensive disease.

Biologic therapy, used by more than 61% of the cohort, was notably associated with worse financial toxicity (P = .0097).

“Notably, the association between biologic use and worse [financial toxicity] likely reflects the substantial out-of-pocket costs patients bear in the US health care system,” the authors explained. “In universal health care settings, where biologic costs are largely absorbed by the system, this relationship could be reversed, as improved disease control may reduce flares, health care visits, and overall financial burden.”

One counterintuitive finding emerged around family history. Patients who reported a family history of HS had lower financial toxicity (P = .01), suggesting that earlier disease recognition, shared coping strategies, and familiarity with the health care system may reduce the financial toll of managing the condition over time.

Addressing Financial Toxicity in HS Treatment

The findings arrive as the HS treatment landscape has expanded considerably. There are now 3 approved biologics for the condition, and of them, only adalimumab has approved biosimilars.² These biologics carry significant cost and access barriers, but biosimilars do offer potential cost savings.³ Whether or not that promise has materialized can be debated.⁴

HS already carries a heavy indirect economic burden. The condition contributes to substantial declines in work ability and productivity, with impairment during working hours correlating directly with disease severity.⁵

Limitations of the research include its single-center design at a US academic medical center, a relatively small cohort of 114 patients, and reliance on patient-reported data.¹ The authors also noted the absence of a validated disease severity assessment, with Hurley stage and lesion count used as surrogates. The findings may not generalize to community-based practices or health systems outside the US.

“Integrating financial counseling and targeted support into multidisciplinary HS care may mitigate [financial toxicity] and improve patient-centered outcomes,” the authors suggested.

References

1. Shan DM, Smith AD, Lyons CE, et al. Assessing the impact of financial toxicity on quality of life in patients with hidradenitis suppurativa: a cross-sectional survey study. Int J Dermatol. Published online May 5, 2026. doi:10.1111/ijd.70454
2. Jeremias S. FDA approves 10th adalimumab biosimilar, Simlandi. The Center for Biosimilars®. February 24, 2024. Accessed May 19, 2026. https://www.centerforbiosimilars.com/view/fda-approves-tenth-adalimumab-biosimilar-simlandi
3. Mulcahy A, Buttorff C, Finegold K, et al. Projected US savings from biosimilars, 2021-2025. Am J Manag Care. 2022;28(7):329-335. doi:10.37765/ajmc.2022.88809
4. Campbell M. A promise unfulfilled: the state of biosimilars. The Center for Biosimilars. October 2, 2024. Accessed May 19, 2026. https://www.centerforbiosimilars.com/view/a-promise-unfulfilled-the-state-of-biosimilars
5. Petrullo J. HS leads to substantial decline in work ability, productivity. AJMC. August 24, 2023. Accessed May 19, 2026. https://www.ajmc.com/view/hs-leads-to-substantial-decline-in-work-ability-productivity