08/12/2014    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2

RE: The High Cost of Topical Anti-Fungals (Elliot Udell, DPM)

From: David E Gurvis, DPM

 

I agree with Drs. Sullivan and Udell. We are allegedly taught how to evaluate the numerous studies which are presented to us almost daily. If a new topical anti-fungal has a significant cure or clearance rate vs a cheaper alternative, then fine. But considering how slow a progression onychomycosis undergoes….use these new medications “in their place.”  If the data is good, then I might use them for patients who won’t take terbinafine due to fear or can’t take it due to pre-existing liver disease; maybe after a cheaper alternative topical has failed to show any efficacy.

 

I recently took a webinar on a topical anti-fungal cream. A participant had prescribed it, and the patient called back asking for an alternative. The medicine in question, being not covered by insurance, was about $350 for a two-week supply, which the patient wouldn’t or couldn’t afford. The moderator’s reply was that it is the doctor’s responsibility to convince patients of the efficacy of this medication so they would pay out of pocket. Um…balderdash! Poppycock! And several other terms which our esteemed moderator would not allow me to publish. Feel free to come up with your own terminology for this reply.

 

Hell, some days, with some patients, we all have trouble convincing them of the efficacy of a pair of orthotics that could last years, much less an equally expensive two-week supply of a cream! Do what is right for your patient and you won’t go wrong.

 

David E Gurvis, DPM, Avon, IN, Deg1@comcast.net