Cost of hidradenitis suppurativa surgical procedures ‘rising sharply’ with inflation
Key takeaways:
- HS unroofing for certain anatomic locations increased by as much as 116%.
- Dermatologists must help guide patients toward better coverage and education on HS treatment.
The cost to treat hidradenitis suppurativa has increased by as much as 116% after adjustment for inflation, causing a historically disadvantaged group of patients to pay higher out-of-pocket costs, according to a study.
In a research letter published in JAMA Dermatology, Peter Khoury, MJ, MHA, a medical student at Kansas City University College of Osteopathic Medicine, and colleagues wrote that the opportunity cost of treating HS compared with simpler conditions is amplified due to its prevalence in marginalized groups.

“It is well established that HS disproportionately impacts individuals from disadvantaged populations and those of low socioeconomic status,” Khoury told Healio. “Currently, there is no cure; however, there are treatments to help manage symptoms and improve quality of life.”
One of the most common procedures for HS is unroofing, where a surgeon removes tissue to expose the HS tunnels under the skin. People with HS are less likely to have health insurance coverage, Khoury told Healio, making these procedures potentially expensive for patients.
In the research letter, Khoury and colleagues investigated the cost of unroofing procedures and medical inflation from 2005 to 2020. The researchers used the IBM MarketScan Commercial Claims and Encounters Database, which included 175.3 million commercially insured U.S. residents.
Results showed that the total adjusted cost per claim substantially increased for unroofing procedures in various anatomic locations, categorized by most CPT codes, from 2005 to 2020:
- CPT 11462 (simple/intermediate inguinal unroofing) increased by 116%;
- CPT11471 (complex perianal, perineal and umbilical unroofing) increased by 80.6%; and
- CPT 11451 (complex axillary unroofing) increased by 56%.
Similarly, researchers observed strong positive correlations between patient out-of-pocket expenses and total cost per claim:
- CPT 11450, a simple/intermediate unroofing in the axillary region (Pearson r = 0.89; 95% CI, 0.7-0.96);
- CPT 11451 (Pearson r = 0.82; 95% CI, 0.55-0.94);
- CPT 11462 (Pearson r, 0.92; 95% CI, 0.79-0.97);
- CPT 11470, a simple/intermediate unroofing in the perianal, perineal or umbilical region (Pearson r, 0.85; 95% CI, 0.61-0.95); and
- CPT 55620, unroofing in the vulva, perineum or introitus region (Pearson r, 0.91; 95% CI,0.75-0.97).
“Treatment costs for HS are rising sharply, placing added financial strain on an already vulnerable population as out-of-pocket costs often track total procedure costs,” Khoury told Healio. “This suggests inflationary pressures may be directly passed onto patients.”
A limitation of this study is that the CPT codes can be associated with diseases other than HS because HS-specific reimbursement procedure codes do not exist, according to Khoury.
“The extensive time, complexity, resources and effort associated with some treatments are likely insufficiently reflected in exiting codes,” Khoury said. “There is a clear need to incentivize providers to treat HS through equitable reimbursement strategies, while reducing confusion when billing and coding for these services.”
Khoury also noted that while the number of claims has decreased over time, Medicare or Medicaid claims were not included in this study. Considering HS disproportionately impacts socioeconomically disadvantaged people, the inclusion of these claims would likely show an increase in deroofing procedures, further emphasizing the need for higher reimbursements to dermatologists to perform these procedures.
“Patient advocacy in HS is critical to ensure that effective treatments are available nationally and maybe more importantly in rural, inner-city and low-income areas,” Khoury said. “Dermatologists and their teams play an important role in supporting patient access to both HS treatments and information on available insurance resources, such as Medicaid, where needed and for those who may qualify.”
For more information:
Peter A. Khoury, MJ, MHA, can be reached at peter.khoury@kansascity.edu.