Debemos cutlivar antes de tratar... las onicomicosis.

Published in Dermatology

Journal Scan / Research · October 09, 2017

Confirming Onychomycosis Before Treatment Is Cost-Effective

Journal of cutaneous medicine and surgery

Abstract:

BACKGROUND

Onychomycosis can be investigated by sampling. Information gleaned includes nail bed involvement, nail plate penetration, fungal viability, and species identification. Testing samples can confirm a diagnosis. While diagnostic testing is considered useful in directing therapy, a substantial number of clinicians do not confirm diagnosis prior to treatment.

OBJECTIVES

The aim of this study is to quantify the benefit of confirmatory testing prior to treating toenail onychomycosis.

METHODS

The cost of mycological cure (negative potassium hydroxide and negative culture) and the cost-effectiveness of confirmatory testing were determined using the average cost of potassium hydroxide (KOH), culture, periodic acid-Schiff (PAS), efinaconazole, ciclopirox, terbinafine, and itraconazole. Costs were obtained through literature searches, public domain websites, and telephone surveys to local pharmacies and laboratories. To represent the potential risks of prescribing onychomycosis treatment, the costs associated with liver monitoring, potential life-threatening adverse events, and drug-drug interactions were obtained through public domain websites, published studies, and product inserts.

RESULTS

PAS was determined to be the most sensitive confirmatory test and KOH the least expensive. The overall cost of an incorrect diagnosis (no confirmatory test used) ranged between $350 and $1175 CAD per patient for treatment of 3 infected toenails. Comparatively, performing confirmatory testing prior to treatment decreases the overall cost to $320 to $930, depending on the therapy, physician, and test.

CONCLUSIONS

It is preferred to diagnose onychomycosis prior to treatment. Furthermore, there are cost savings when confirmatory testing is performed before initiating treatment with both topical and oral antifungals in Canada.

Journal of cutaneous medicine and surgery

Confirmatory Testing Prior to Initiating Onychomycosis Therapy Is Cost-Effective

J Cutan Med Surg 2017 Sep 27;[EPub Ahead of Print], AK Gupta, SG Versteeg, NH Shear 

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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