Financial Toxicity Linked to Worse Quality of Life in HS

As hidradenitis suppurativa (HS) treatment becomes increasingly complex and increasingly expensive, new research suggests that financial toxicity may play a significant role in patient quality of life (QOL), independent of disease severity alone.

In a recent cross-sectional survey study published in the International Journal of Dermatology, investigators evaluated the relationship between financial toxicity and QOL in patients with HS receiving care at a US academic specialty clinic.¹ The findings underscore the need for dermatology clinicians to consider financial strain as part of routine HS assessment and management.

“Financial toxicity is a robust, independent predictor of QOL in HS,” the authors concluded. “Greater disease involvement and psychiatric and cardiovascular comorbidities may increase financial strain, while a family history of HS may reduce burden through earlier recognition and intervention. Integrating financial counseling and targeted support into multidisciplinary HS care may mitigate financial toxicity and improve patient-centered outcomes.”

Measuring Financial Burden in HS

Financial toxicity refers to the negative impact health care costs can have on a patient’s overall well-being and daily functioning. Although commonly discussed in oncology, the concept is increasingly relevant in dermatology, particularly in chronic inflammatory diseases requiring ongoing specialty care and biologic therapy.²

The study included 114 patients with HS who completed the validated Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey and the Dermatology Life Quality Index (DLQI). Higher COST-FACIT scores indicate lower financial toxicity, whereas higher DLQI scores reflect worse dermatology-related QOL.

The patient population reflected a high disease burden. Most participants had Hurley stage II or III disease, and 64% had involvement of 3 or more anatomic sites. Mean DLQI scores were consistent with severe QOL impairment.

Financial Toxicity Directly Affected QOL

After adjusting for demographic variables including age, sex, race, marital status, and employment status, researchers found a significant association between lower financial toxicity and better QOL outcomes.

Specifically, each 1-point increase in COST-FACIT score corresponded to a 0.448-point decrease in DLQI score, suggesting that reduced financial burden was associated with meaningful improvements in patient-reported QOL.

For clinicians managing HS longitudinally, the findings reinforce that treatment success may involve more than disease control alone. Even patients responding clinically to therapy may continue experiencing substantial psychosocial and financial stressors that affect adherence, follow-up, and overall satisfaction with care.

Which Patients Were Most Affected?

Several clinical characteristics were associated with worse financial toxicity.

Patients with psychiatric disease reported significantly lower COST-FACIT scores, as did those with tobacco use and more extensive anatomic disease involvement. Cardiovascular comorbidities were also independently associated with increased financial strain.

Biologic therapy use emerged as another factor associated with worse financial toxicity. Although biologics remain an important treatment option for moderate to severe HS, the authors noted that out-of-pocket expenses, insurance hurdles, prior authorizations, and variable manufacturer assistance programs likely contribute to patient burden in the US health care system.

The study authors also pointed out that this relationship may differ in universal health care systems where biologic costs are less directly transferred to patients.

Interestingly, patients with a family history of HS reported lower financial toxicity scores. Researchers suggested that earlier recognition of symptoms, familiarity with treatment pathways, and shared coping strategies may help reduce burden in these patients.

Clinical Implications for Dermatology Clinicians

For clinicians, the findings highlight the importance of screening for practical barriers to care during HS visits. Financial strain may influence medication adherence, appointment attendance, procedural follow-through, and willingness to escalate therapy.

Routine discussions about insurance coverage, copay assistance programs, transportation challenges, and access to multidisciplinary support may help identify patients at risk for worsening financial toxicity before it impacts outcomes.

The authors concluded that integrating financial counseling and targeted support services into multidisciplinary HS care models may help improve patient-centered outcomes and reduce overall disease burden.

Although limited by its single-center design and reliance on patient-reported measures, the study adds to growing evidence that the economic impact of HS deserves greater attention in clinical practice—particularly as treatment paradigms continue evolving toward long-term biologic management.

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. Pisu M, Martin MY. Financial toxicity: a common problem affecting patient care and health. Nat Rev Dis Primers. 2022;8(1):7. doi:10.1038/s41572-022-00341-1