Cost-effectiveness of diagnostic tests for toenail onychomycosis: A repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests - 09/08/11
Correspondence to: Erin M. Warshaw, MD, MS, Department 111K–Dermatology, 1 Veterans Dr, Minneapolis, MN 55417.Minneapolis, Minnesota
Abstract |
Objective |
Our purpose was to estimate and compare the cost-effectiveness of the most commonly used diagnostic tests for onychomycosis: potassium hydroxide preparation (KOH), interpreted both by a dermatologist (KOH-CLINIC) and a laboratory technician (KOH-LAB); KOH with dimethyl sulfoxide (KOH-DMSO) and with chlorazol black E (KOH-CBE), interpreted by a dermatologist; culture using dermatophyte test medium, culture with Mycobiotic and Inhibitory Mold Agar (Cx); and histopathologic analysis using periodic acid–Schiff stain (PAS).
Methods |
This was a repeated-measure, blinded, cross-sectional study conducted at the Minneapolis Veterans Affairs Medical Center. Inclusion criteria included: at least one toenail with 25% or more clinical disease, which was defined as subungual debris with onycholysis and/or onychauxis. Exclusion criteria included other nail dystrophies, use of oral antifungal medication for 2 months or longer within the past year, or topical ciclopirox lacquer within 6 weeks of enrollment. The main outcome measure was the cost-effectiveness (Medicare and non-Medicare costs) of 7 diagnostic tests. Sensitivity (at least 3 positive tests) was the unit of effectiveness.
Results |
Two hundred four participants were enrolled; their average age was 69.5 years and 95.5% were male. PAS was the most sensitive test (98.8%); it was statistically significantly more sensitive than all other diagnostic tests except KOH-CBE (94.3%). Dermatophye test medium was the least sensitive test (57.3%). KOH-CBE was statistically significantly more cost effective than any other test, with the exception of KOH-CLINIC and KOH-LAB. PAS was the least cost effective.
Limitations |
Test specificities were not evaluated.
Conclusion |
KOH-CBE should be the test of choice for practitioners confident in interpreting KOH preparations because of its combination of high sensitivity and cost-effectiveness.
Le texte complet de cet article est disponible en PDF.Abbreviations used : cv, Cx, DTM, HSD, KOH, KOH-CBE, KOH-CLINIC, KOH-DMS, KOH-LAB, PAS, ts
Plan
| Supported by a Minnesota Medical Foundation Medical Student Research Grant and the Minneapolis Veterans Affairs Medical Center and its Center of Excellence on Chronic Disease Outcomes Research. Disclosure: During this study, Dr Warshaw’s career was supported by a VA Cooperative Studies Career Development Award in Clinical Research. This study was presented, in part, as a poster at the 62nd Annual Meeting of the American Academy of Dermatology, February 2004, and at the Council for Nail Disorders, February 2004 (oral presentation). Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position of policy of the Department of Veterans Affairs. Reprints not available from the authors. |
Vol 55 - N° 4
P. 620-626 - octobre 2006 Retour au numéro
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