Empirical Treatment More Cost-Effective for Onychomycosis
HealthDay News — For patients with suspected onychomycosis, empirical treatment with terbinafine is more cost-effective than confirmatory testing, according to a study published online Dec. 23 in JAMA Dermatology.
Anar Mikailov, MD, from Brigham and Women's Hospital in Boston, and colleagues examined the cost and potential harm associated with three approaches to onychomycosis evaluation before oral terbinafine or efinaconazole 10% treatment. A decision analysis compared the costs of three management algorithms: empirical therapy without confirmatory testing; pretreatment confirmatory testing with potassium hydroxide (KOH) stain followed by periodic acid-Schiff (PAS) evaluation if KOH was negative; and pretreatment testing with PAS.
The researchers found that the per-patient cost savings of empirical terbinafine therapy without confirmatory testing was $47 compared with the KOH screening model, and $135 compared with PAS testing, at a disease prevalence of 75%. To prevent a single case of clinically relevant liver toxic effects related to terbinafine, the required cost of testing was between $18.2 million and $43.7 million for KOH screening and between $37.6 million and $90.2 million for PAS testing, at a prevalence of 75%. KOH screening and PAS testing before 10% efinaconazole treatment correlated with saving of $272 and $406 per patient per nail, respectively, at a prevalence of 75%.
"Blanket recommendations for confirmatory testing before systemic therapy should be reconsidered and replaced with recommendations tailored to specific therapies," the authors write.
One author is employed by Walgreens.