Cost-effectiveness of diagnostic tests for toenail onychomycosis: A repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests
Cost-effectiveness of diagnostic tests for toenail onychomycosis: A repeated-measure, single-blinded, cross-sectional evaluation of 7 diagnostic tests
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DOI：
10.1016/j.jaad.2006.03.033
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发表时间：
2006-10-01
影响因子：
13.8
通讯作者：
Warshaw, Erin M.
中科院分区：
文献类型：
--
作者：
Lilly, Kia K.;Koshnick, Rebecca L.;Warshaw, Erin M.
目的：我们的目的是评估和比较甲真菌病最常用的诊断测试的成本效益：氢氧化钾制剂（KOH），由皮肤科医生解释（KOH-CHAIC）和一名实验室技术员（KOH-LAB）; KOH和二甲基亚砜（KOH-DMSO）和氯唑黑E（KOH-CBE），由皮肤科医生解释;采用皮肤真菌试验培养基进行培养，用真菌和抑制霉菌琼脂（Cx）进行培养，并采用过碘酸-希夫染色（PAS）进行组织病理学分析。这是一项在明尼阿波利斯退伍军人事务医疗中心进行的重复测量、设盲、横断面研究。入选标准包括：至少一个趾甲有25%或以上的临床疾病，定义为甲下碎片伴甲松解和/或甲肥大。排除标准包括其他指甲营养不良，在过去一年内使用口服抗真菌药物2个月或更长时间，或在入组前6周内局部使用环吡酮漆剂。主要结果指标是7种诊断测试的成本效益（医疗保险和非医疗保险成本）。灵敏度（至少3次阳性试验）是有效性的单位。204名参与者入组，他们的平均年龄为69.5岁，95.5%是男性。PAS是最敏感的试验（98-8%）;它在统计学上比除KOH-CBE（94.3%）外的所有其他诊断试验更敏感。皮肤真菌试验培养基的敏感性最低（57.3%）。KOH-CBE在统计学上比任何其他测试都更具成本效益，KOH-ABIC和KOH-LAB除外。考绩制度的成本效益最低。局限性：测试特异性没有evaluated.Conclusion：KOH-CBE应该是测试的选择从业者有信心解释KOH的准备，因为它的组合的高灵敏度和成本效益。
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 mate. 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.