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.     

Management in a complex scenario: World Cup,alternative stadiums and demand for tickets

This paper analyses a particular managerial problem that sports clubs face from time to time. The aim is to identify the effects that alternative stadiums and stadiums' features have in ticket prices and demand. Simultaneous equations models by three-stage least square estimator using instrumental variables is the method employed. The findings evidence that alternative stadiums negatively impact attendances, but clubs can offset this effect playing at high-quality alternative stadiums. Results also evidence that fans care about security levels. Some policies for football leagues are discussed as limits in the use of alternative stadiums, league fixtures and hard requirements concerning security.