1 Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.
2 Mediprobe Research, London, ON, Canada.
J Cutan Med Surg. 2018 Mar/Apr;22(2):129-141. doi: 10.1177/1203475417733461. Epub 2017 Sep 27.
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.
The aim of this study is to quantify the benefit of confirmatory testing prior to treating toenail onychomycosis.
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.
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.
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.
甲真菌病可通过采样进行检查。收集的信息包括甲床受累、甲板穿透、真菌活力和菌种鉴定。检测样本可确诊。虽然诊断性检测被认为有助于指导治疗，但相当多的临床医生在治疗前并未确诊。
本研究旨在量化治疗趾甲甲真菌病前进行确诊性检测的获益。
使用氢氧化钾（KOH）、培养、过碘酸-Schiff（PAS）、依氟康唑、环吡酮、特比萘芬和伊曲康唑的平均成本，确定真菌学治愈（KOH 和培养均为阴性）的成本和确诊性检测的成本效益。成本通过文献检索、公共域网站以及对当地药店和实验室的电话调查获得。为了体现开具甲真菌病治疗药物的潜在风险，通过公共域网站、已发表的研究和产品说明书获取与肝监测、潜在危及生命的不良事件和药物相互作用相关的成本。
PAS 被确定为最敏感的确诊性检测，而 KOH 则是最便宜的。在未进行确诊性检测的情况下，对 3 个感染趾甲进行治疗的每位患者的总体错误诊断（未进行确诊性检测）成本在 350 至 1175 加元之间。相比之下，在治疗前进行确诊性检测可将总成本降低至 320 至 930 加元，具体取决于治疗药物、医生和检测方法。
在治疗前诊断甲真菌病更为理想。此外，在加拿大，对局部和口服抗真菌药物进行治疗前进行确诊性检测，可节省成本。
