Economic impact of contrast-induced acute kidney injury associated with invasive cardiology: role of iso-osmolar contrast media in Germany,Italy, Poland,and Spain

Objective:

Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiography (CA) with or without percutaneous coronary intervention (PCI) in German, Italian, Polish and Spanish hospitals.

Methods:

This budget impact analysis (BIA) compared a scenario with iodixanol to a scenario without, where only LOCM were used, in patients at increased risk of CI-AKI over a 3-year horizon. A meta-analysis based on a systematic review observed a lower rate of CI-AKI with iodixanol compared to LOCM (Risk Reduction?=?0.46) in patients with underlying impaired renal function (serum creatinine ≥1.6?mg/dl and estimated glomerular filtration rate ≤50?ml/min/1.73 m²). Contrast media and CI-AKI hospitalization costs were included in the analysis and unit costs were obtained from published literature, official sources or, when available, from hospital data. In the absence of country-specific data, resource utilization for a CI-AKI hospitalization was obtained by interviews with local clinicians in each country. The percentage of patients who received iodixanol was assumed to increase over time.

Results:

Based on a percentage of patients at increased risk of CI-AKI equal to 20% in Germany, 24% in Italy, 23% in Poland and 10% in Spain, results showed that the introduction of iodixanol would bring a 3-years cumulative net percentage saving on the total hospital budget of 29%, 34%, 25%, and 33% in the four countries respectively.

Conclusion:

The results of the analysis for the four countries showed that iodixanol use in patients at increased risk of CI-AKI undergoing CA with or without PCI may bring considerable savings on the hospital’s budget, due to the associated reduction in CI-AKI incidence.     

On the appropriate objective function for post-disaster humanitarian logistics models

The paper argues that welfare economic principles must be incorporated in post-disaster humanitarian logistic models to ensure delivery strategies that lead to the greatest good for the greatest number of people. The paper's analyses suggest the use of social costs—the summation of logistic and deprivation costs—as the preferred objective function for post-disaster humanitarian logistic models. The paper defines deprivation cost as the economic valuation of the human suffering associated with a lack of access to a good or service. The use of deprivation costs is evaluated with a review of the philosophy and the economic literature to identify proper foundations for their estimation; a comparison of different proxy approaches to consider human suffering (e.g., minimization of penalties or weight factors, penalties for late deliveries, equity constraints, unmet demands) and their implications; and an analysis of the impacts of errors in estimation. In its final sections, the paper conducts numerical experiments to illustrate the comparative impacts of using the proxy approaches suggested in the literature, and concludes with a discussion of key findings.     

Supply chain risk: empirical research in the automotive industry

Supply chain risk management (SCRM) has become a popular topic over the past decade. It is not a surprise that the automotive industry has been a motivating arena for research within this field; however, the few existing empirical studies reveal that SCRM practices within this industry are still in their infancy. Because the identification of risks can be viewed as the trigger for SCRM, attempts to develop a risk profile for this industry that could serve as a guide to start the SCRM process are needed. This research identifies the main risks along the automotive supply chain by investigating their manifestation in three supply chains in Brazil and offers an initial risk profile for the Brazilian automotive industry. Although the importance of SCRM has been recognised by all analysed companies, the research findings underline the lack of preparedness regarding either identifying risk or considering risk-mitigation strategies and risk assessment. In this context, this study identifies the main risk in which a supply chain can be exposed, through the analysis of real-life manifested risks along different supply chains, as a way to help the supply chain start a SCRM process.     

Consumption and Hedging in Oil‐Importing Developing Countries

We study the consumption and hedging strategy of an oil‐importing developing country that faces multiple crude oil shocks. In our model, developing countries have two particular characteristics: their economies are mainly driven by natural resources and their technologies are less efficient in energy usage. The natural resource exports can be correlated with the crude oil shocks. The country can hedge against the crude oil uncertainty by taking long/short positions in existing crude oil futures contracts. We find that both inefficiencies in energy usage and shocks to the crude oil price lower the productivity of capital. This generates a negative income effect and a positive substitution effect, because today’s consumption is relatively cheaper than tomorrow’s consumption. Optimal consumption of the country depends on the magnitudes of these effects and on its risk‐aversion degree. Shocks to other crude oil factors, such as the convenience yield, are also studied. We find that the persistence of the shocks magnifies the income and substitution effects on consumption, thus also affecting the hedging strategy of the country. The demand for futures contracts is decomposed in a myopic demand, a pure hedging term and productive hedging demands. These hedging demands arise to hedge against changes in the productivity of capital due to changes in crude oil spot prices. We calibrate the model for Chile and study to what extent the country’s copper exports can be used to hedge the crude oil risk.     

The Aggregate Production Function: ‘Not Even Wrong’

The foundations of the aggregate production function were long ago thrown into doubt by problems of aggregation and the Cambridge capital theory controversies. Yet the aggregate production function, whether in the familiar form of the Cobb-Douglas, the CES, or the translog, continues to be widely used in both theoretical and applied analysis. The reason for its continued use rests on the instrumental position that ‘it works’. The aggregate production function sometimes yields good statistical fits with plausible estimates of the coefficients. However, for some time, it has been realised that the existence of an underlying accounting identity can explain the regression results, even if the aggregate production function does not exist. This argument has been widely ignored. This paper, drawing on a rhetorical approach, assesses why this is the case. It shows that the few criticisms that have been made of the critique involve fundamental misunderstandings that represent a failure of the economic method.     

The impact of income redistribution on aggregate consumption

Atlantic Economic Journal -     

The codispersion map: a graphical tool to visualize the association between two spatial variables

The codispersion coefficient quantifies the association between two spatial processes for a particular direction (spatial lag) on a two‐dimensional space. When this coefficient is computed for many directions, it is useful to display those values on a single graph. In this article, we suggest a graphical tool called a codispersion map to visualize the spatial correlation between two sequences on a plane. We describe how to construct a codispersion map for regular and non‐regular lattices, providing algorithms in both cases. Three numerical examples are given to illustrate how useful this map can be to detect those directions for which the codispersion coefficient attains its maximum and minimum values. We also provide the R code to construct the codispersion map in practice.     

The influence of socioemotional wealth in the entrepreneurial orientation of family businesses

This study analyses the effect of socioemotional wealth on the entrepreneurial orientation of family businesses. Entrepreneurship, measured through entrepreneurial orientation, is a key factor for the survival of family businesses. Second-generation structural equation method (PLS-SEM) was used to analyse the results, specifically, the SmartPLS 3.2.7 software applied to data on106 Spanish family businesses. The main contribution of this study is to show that family businesses provide an adequate framework for analysing entrepreneurship from an entrepreneurial orientation. Second, the FIBER measurement model for socioemotional wealth allows capturing the special behaviour of family businesses. Finally, with this study we ascertain that socioemotional wealth positively influences entrepreneurial orientation, thus explaining 32.6% of its variance.

     

Polymyxin B and colistin—the economic burden of nephrotoxicity against multidrug resistant bacteria

Background: Polymyxin B and colistin are nephrotoxic drugs used in the treatment of carbapenem-resistant Enterobacteriaceae. The aim of this study is to evaluate the burden of costs due to polymyxin associated AKI and propose a simulated break-even price for new therapies.

Methods: The pharmacoeconomic model is based on two large cross-sectional studies of polymyxin nephrotoxicity. Total direct costs in patients with and without renal failure were compared. The direct cost of each hemodialysis section (USD82.94) and daily hospital charges (USD934.85) were based on the values used in a major public hospital in the city where the clinical study was performed. The break-even price of new drugs was simulated considering eventual new drugs as effective as polymyxins, but less nephrotoxic in different percentages. Outcomes of patients after hospital discharge were not evaluated.

Results: Total direct cost of the group of patients who survived without AKI was significantly lower than total direct cost of the groups either with AKI or the group who died without AKI. There was a tendency of even higher costs in those who died with AKI and dialysis. Direct cost of hemodialysis was not as important as the longer hospitalization after sepsis. Considering daily cost of polymyxin is USD60, drugs with 50% less AKI could be considered cost-beneficial if the daily cost is lower than USD160.

Conclusions: AKI in patients with carbapenem-resistant Enterobacteriaceae treated with polymyxin increases both length of stay in hospital and total costs.     

Correcting for biases when estimating production functions: an illusion of the laws of algebra?

This paper shows that the endogeneity bias that allegedly appearswhen estimating production functions using value data, and whichthe literature has tried to deal with since the 1940s, is simplythe result of omitted-variable bias due to a poor approximationto an accounting identity. This problem has no econometric solution.As a result, recent attempts to solve the problem by developingnew estimators are questioned. The only possible way to estimatethe technological parameters of the production function is touse physical quantities.