Boston—When is confirmatory testing cost effective in nail fungus treatment? An analysis in JAMA Dermatology based on previously published data provides an answer to that question. The study led by Brigham and Women’s Hospital researchers suggests it is more cost effective to treat all suspected cases of onychomycosis with the oral medication terbinafine than to perform confirmatory diagnostic tests. On the other hand, costs were reduced when confirmatory testing was employed before prescribing the pricey topical medicine efinaconazole—a savings of $272 and $406 per patient per nail using potassium hydroxide screening and periodic acid-Schiff testing, respectively. Background information in the article notes that onychomycosis is the most common disease of the nail in adults, with a prevalence of 7% to 14% of individuals in North America.