Onychomycosis, the fungal infection of the toenails, is a most common nail disease in the adult population, so it is only logical that the cost-effectivness of the different healing therapies should be checked thoroughly and the efficacy of the confirmatory tests to be proved. It is just what some researchers of Brigham and Women’s Hospital’s Dermatology Department did. Guided by dr Arash Mostaghimi, they evaluated two therapies: one with terbinafine, an oral pill, or a topical solution of efinaconazole, 10 percent (Jublia).

The treatment and monitoring for the oral pill cost an average of 53 $; a full course of treatment with the topical solution costs 2,307 $ per nail. For the oral pill, the price of confirmatory testing exceeded the cost of treating all suspected cases. It has also been noted that cases of adverse effects from treatment are very rare, so the cost to avoid one case of liver injury would be between 18.2 and 90.2 million $.

As for the topical solution, instead, confirmatory testing before treatment substantially reduced costs, suggesting that confirmatory testing should still be used before beginning treatment with efinaconazole.

The authors concluded that “Blanket recommendations for confirmatory testing before systemic therapy should be reconsidered and replaced with recommendations tailored to specific therapies,” the authors write.