| Summary: | Efinaconazole topical solution 10% w/w (Jublia) is a triazole antifungal agent indicated for the topical treatment of mild-to-moderate onychomycosis (tinea unguium) of toenails without lunula involvement due to Trichophyton rubrum and T. mentagrohytes in immunocompetent adult patients. Efinaconazole is available in 8 mL bottles at a submitted price of $89.04 per bottle. The product monograph recommends applying one drop of the solution topically to the affected toenail(s) once daily, preferably at bedtime, with a second drop applied to the affected great toenail(s). At the recommended dose, a patient with a single affected great toenail would require two bottles over 48 weeks of therapy, i.e., the duration of therapy in the manufacturer's pivotal clinical trials, at a cost of $178 per patient. A patient with one affected great toenail and three smaller toenails, which is consistent with the median in the pivotal trials of four affected toenails per patient, would require five bottles over the 48-week period, at a cost of $445. The manufacturer submitted a cost-utility analysis in the form of a decision-tree model comparing efinaconazole as first-line therapy with no treatment in adults with mild-to-moderate onychomycosis
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