{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T08:03:56Z","timestamp":1759565036429,"version":"3.40.5"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Dermatology"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%\u201310%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real\u2010world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well\u2010established oral medication, experienced a substantial decrease in prescription volume. The sex\u2010 and age\u2010adjusted prescription volume per 100\u2009000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019\u20132021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first\u2010line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost\u2010effective treatment strategies. This study provides valuable insights into the real\u2010world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.<\/jats:p>","DOI":"10.1111\/1346-8138.17393","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T13:34:31Z","timestamp":1723124071000},"page":"1172-1179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of new antifungal medications on onychomycosis prescriptions and costs in Japan: A nationwide claims database study"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2549-6690","authenticated-orcid":false,"given":"Hideaki","family":"Miyachi","sequence":"first","affiliation":[{"name":"Center for Next Generation of Community Health Chiba University Hospital  Chiba\u2010shi Chiba Japan"},{"name":"Department of Dermatology Chiba University Hospital  Chiba\u2010shi Chiba Japan"},{"name":"Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Sato","sequence":"additional","affiliation":[{"name":"Hospital and Health Administration, Fujita Health University Graduate School of Medicine  Toyoake Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Sakamaki","sequence":"additional","affiliation":[{"name":"Center for Next Generation of Community Health Chiba University Hospital  Chiba\u2010shi Chiba Japan"},{"name":"Faculty of Health Data Science, Juntendo University  Urayasu Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8472-3609","authenticated-orcid":false,"given":"Yaei","family":"Togawa","sequence":"additional","affiliation":[{"name":"Department of Dermatology Chiba University Hospital  Chiba\u2010shi Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kensuke","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Center for Next Generation of Community Health Chiba University Hospital  Chiba\u2010shi Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.12323"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.03.062"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.15618"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1346-8138.2011.01209.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.16991"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1203475417716362"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3812\/jocd.33.630"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.3812\/jocd.34.742"},{"key":"e_1_2_8_10_1","first-page":"1076","article-title":"Therapeutic recommendations for the treatment of toenail onychomycosis in the US","volume":"20","author":"Lipner SR","year":"2021","journal-title":"J Drugs Dermatol"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/ddg.14988","article-title":"S1 Guideline onychomycosis","volume":"21","author":"Nenoff P","year":"2023","journal-title":"J Dtsch Dermatol Ges"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3812\/jocd.40.44"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.17110"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.37737\/ace.23008"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.31662\/jmaj.2023-0078"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0291673"},{"key":"e_1_2_8_17_1","unstructured":"NDB Open Data Japan website. 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