Real-World Data Highlight Cost and Utilization Benefits of Early HS Diagnosis

A formal diagnosis of hidradenitis suppurativa is associated with meaningful improvements in treatment trajectory and healthcare resource utilization compared with suspected but undiagnosed disease—yet racial, ethnic, and socioeconomic disparities continue to shape the patient journey even after diagnosis is established.¹

A recent retrospective cohort study, led by Raj Chovatiya, MD, PhD, of Rosalind Franklin University of Medicine and Science and Dermatology Times editorial advisory board member, drew on data from the US Premier Healthcare Database (PHD) and its linked medical and pharmacy claims database, which captures hospital discharge and billing data from more than 1,300 hospitals across all 9 US census divisions. Investigators compared outcomes between adult and pediatric patients with confirmed HS and those with suspected but undiagnosed HS—defined as patients presenting with HS-associated symptoms including abscess, cyst, boil, furuncle, and/or folliculitis—across a study period spanning January 2018 through December 2022.²

The final analytic cohort included 3,411 patients with confirmed HS (3,065 adults; 346 pediatric) and 28,799 patients with suspected HS (27,280 adults; 1,519 pediatric).

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Diagnosis Accelerates Treatment and Reduces Hospitalizations

Among adult patients, a confirmed HS diagnosis was associated with significantly faster initiation of biologic therapy following the index visit—a mean of 109.8 days compared with 165.5 days in the suspected HS cohort. Adult patients with confirmed HS were also more likely to use biologics overall (12.8% vs 1.3%) and to spend more time on antibiotic treatment prior to their first dermatology visit (33.4 vs 19.3 days) and prior to biologic initiation (44.2 vs 23.1 days)—findings the authors interpret as evidence that a confirmed diagnosis prompts earlier, more comprehensive, multimodal disease management rather than symptom-targeted treatment alone.

Consistent with that interpretation, adult patients with confirmed HS also underwent significantly more surgical procedures for disease-related treatment before their first dermatology visit (mean 3.0 vs 1.5 procedures). Biologic and surgical use rates were lower in the pediatric cohorts but followed a similar directional pattern, with significantly more pediatric HS patients using biologics than their suspected HS counterparts (9.0% vs 0.6%).

From a health care resource utilization standpoint, both the adult and pediatric HS cohorts demonstrated meaningfully lower 30-day risks of all-cause hospitalization and all-cause emergency department visits following the index visit. In adults, the 30-day hospitalization risk was 0.8% among confirmed HS patients versus 3.7% in the suspected HS group; ED visit risk was 2.6% versus 11.7%. Pediatric HS patients showed an even more pronounced gap in ED risk (2.9% vs 18.4%).

Lower health care utilization in high-acuity settings translated to cost differences as well. During the follow-up period, adult patients with confirmed HS incurred significantly lower overall costs than those with suspected HS ($22,128 vs $36,359). The authors note that timely, focused disease management in outpatient settings may reduce the complications and disease progression that drive costly inpatient admissions.

Disparities Persist Along Racial, Ethnic, and Socioeconomic Lines

Despite the clear advantages associated with a confirmed diagnosis, the study found significant variation in the treatment journey across race, ethnicity, and social determinants of health. Among adult patients with confirmed HS, time from diagnosis to biologic initiation was significantly different across ethnic groups—Hispanic patients faced the longest delays, averaging more than 53 additional days compared to the overall adult HS population. Black adult patients experienced delays averaging approximately 27.5 additional days. Among adults, time on antibiotics prior to the first dermatology visit also differed significantly by social vulnerability index (SVI) category, with patients in the highest-vulnerability tier (SVI 0.75–1) experiencing longer treatment gaps.

In pediatric patients with confirmed HS, biologic initiation timing was significantly different across SVI categories, with patients in the 0.25–0.5 SVI range showing particularly pronounced delays. Medicaid-insured pediatric patients also waited substantially longer to initiate biologics compared to commercially insured peers.

Clinical Implications

The authors emphasize that while a confirmed HS diagnosis is clearly beneficial—facilitating structured, multimodal management and reducing costly acute care utilization—the persistent disparities across demographic and socioeconomic groups underscore ongoing gaps in equitable access to timely diagnosis and appropriate treatment. Among the strategies proposed: developing standardized HS screening guidelines, expanding financial assistance programs to offset treatment and transportation costs, and implementing inclusive health policy measures.

References

1. Anthony MR, Abdi P, Farkouh C, Maibach HI. Unmasking racial disparity in the diagnosis and treatment of hidradenitis suppurativa. Cureus. 2023;15(6):e41190. Published 2023 Jun 30. doi:10.7759/cureus.41190
2. Chovatiya R, Gayle J, Low R, Oh T, Gomez I, Rosenthal N. Patient journey and disparities in the diagnosis and treatment of patients with hidradenitis suppurativa. JID Innov. 2026;6(3):100462. Published 2026 Feb 24. doi:10.1016/j.xjidi.2026.100462