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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, M.D., 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 percent 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.

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