I went on it for 5 (or 6?) months when I was 26, seven years ago, and it changed my life for the better. I sing my praises to accutane. Prior to accutane, I would have multiple pimples on my face at any time, and they were painful. I didn't realize how annoying or prevalent or painful they were until a few months after I finished accutane and my first zit post-accutane popped up. Pimples became (and still are) a rare occurrence now.
I did try several other treatments prior to accutane. Over the counter benzoyl peroxide and salicylic acid, prescription benzoyl peroxide, prescription antibiotics, prescription creams- they didn't work. Tried doing all different kinds of diets- nothing. Accutane was the only thing to work. (The only thing I didn't try, ironically, was birth control- hormonal acne can respond well to that.)
I've got a uterus- I know a lot of people have expressed needing to go on birth control while on it, but my doctor believed me when I said I was practicing abstinence. (I was, I wasn't lying.) The official rule is abstinence or two forms of prevention- typically that's some form of pill/IUD and condom combo. I did monthly blood tests to check for liver enzymes and cholesterol- didn't have any issues. I had some dryness on my face and lips, but for the most part wasn't too bad- just lip balm and lotion up.
My face is typically clear- I get an occasional zit once in a while, but it's not the multiple cystic spots I had been getting before. My confidence is so much higher, and I'm less self-conscious about my face. It's been amazing.
My husband also went on accutane in his early 30s for chest and back acne. His course was 4-5 months. He had some dryness and at one point got a nose bleed, but nothing terrible. And his cholesterol and liver enzymes were slightly elevated while on it, but they came back down once he stopped. And now he doesn't have painful acne that pops and gets blood on his shirts.
Cost-wise, when I was on it, by pill co-pay was $7.50. (Yeah, I know, it was amazing.) It's was around $100 for my husband.