Joseph P. Fuhr

Cost-benefit analysis of chlorhexidine gluconate dressing in the prevention of catheter-related bloodstream infections.

OBJECTIVES To compare the costs with the benefits of using chlorhexidine gluconate dressings on central venous catheters and to determine the effectiveness of these dressings in reducing local infections and catheter-related bloodstream infections (CRBSIs), costs, and mortality. DESIGN Cost-benefit analysis using randomized, controlled trial data on chlorhexidine dressing prevention of local infection and CRBSI, data on cost of chlorhexidine dressing versus standard treatment, data on averted cost of treating local infection and CRBSI, and data on mortality attributable to CRBSI. Decision analysis evaluated averted CRBSI treatment cost per patient resulting from chlorhexidine dressing use. Sensitivity analyses demonstrated net benefit of chlorhexidine dressing, varying baseline rate of CRBSI, incremental cost of treating CRBSI, and number of catheters, and evaluated mortality preventable through chlorhexidine dressing use, varying baseline rate of CRBSI, number of catheters, and mortality attributable to CRBSI. PATIENTS AND SETTING Patients of all Philadelphia area hospitals and one Philadelphia academic medical center. RESULTS Estimated potential annual U.S. net benefits from chlorhexidine dressing use ranged from

Hospital mergers and antitrust: an economic analysis.

275 million to approximately

Cost considerations for rural telephone service

1.97 billion. Cost-benefit findings persisted in sensitivity analyses varying baseline rate of CRBSI, incremental cost of treating CRBSI, and overall number of catheters used. Preventable mortality analyses showed potential decreases of between 329 and 3,906 U.S. deaths annually as a result of nationwide use of chlorhexidine dressing. CONCLUSIONS Chlorhexidine dressings would reduce costs, local infections and CRBSIs, and deaths. Use of chlorhexidine dressings should be considered to prevent infections among patients with catheters.

Ask the experts: future of the pharmaceutical industry. Interview by Future Medicinal Chemistry.

The hospital industry has recently experienced substantial merger activity. This paper examines several actual and proposed hospital mergers to determine the extent of competition in the affected markets and the effect these mergers may have on competition. Our focus is on mergers between hospitals in the same market. We define the relevant product and geographic market for hospitals, then develop criteria for evaluating hospital mergers and analyze several merger cases using these criteria. We conclude that these mergers threaten the competition that exists in most of the markets discussed, and that the claimed efficiency justification for mergers is not convincing.

Biosimilars and innovation: an analysis of the possibility of increased competition in biopharmaceuticals

Abstract This study estimates the relationship between density and fixed costs for rural telephone companies, together with several other cost factors, to determine the costs of providing telephone service to different areas. It is found that not all rural companies are high-cost companies; rural cooperatives, for instance, have the lowest operating costs and lowest total expenses per access line. Yet low-interest loans, long-distance settlements and disbursements from the universal service fund are made available to these companies on the basis of only a portion of their costs.

Biosimilars and Follow-on Biologics

The pharmaceutical industry is facing numerous, well-documented challenges - from the effects of patent expirations to high attrition rates in the drug-development pipeline. Future Medicinal Chemistry has invited a group of leaders from academia and industry to express their views on where the industry is heading and speculate as to what role medicinal chemists will play in the future.

Telephone subsidization of rural areas in the USA

The USA is now developing a process for expedited approval of biosimilars. Biopharmaceuticals are far more complex and costly to develop and produce than chemical drugs. Biosimilars raise greater safety issues owing to possible immune responses, are likely to offer smaller percentage price reductions than chemical generics and will probably obtain smaller market shares. Patents may not be as strong for biopharmaceuticals, which are often made by small firms, suggesting the desirability of greater data exclusivity protection. This article suggests that it is better to err on the side of too much protection than too little, given the uncertainties involved.

The rationale for local measured service

This was the Center for Business Intelligence’s 2nd Annual Summit on Biosimilars. The participants included industry, government, academics and private professionals involved in the myriad issues of biosimilars. Its purpose was to present a dialogue to evaluate the legal, regulatory and economic landscape in the USA and abroad and prepare for the anticipated US legislation that will enable the entry of biosimilars. Another conference will be held in September to discuss the various pending biosimilar bills in more detail or the new law, if passed.

Rural telephony since divestiture

This Comment puts under scrutiny the structure of the rural telephone industry in the USA and the subsidies which rural telephone companies and their customers have received and continue to receive. The current system of subsidizing rural telephone subscribers is inefficient and inequitable, the author finds. He examines the future of the rural telephone companies in the light of the regulatory changes that have occurred, and outlines some public policies which would help achieve universal service and improve equity and efficiency.

Competition's flawed perspective on the health care market and an alternative approach.

This article argues the case for a programme of charging telephone customers for their actual usage of the telephone system. The author compares the telephone to other public utilities and shows the inefficiencies which have arisen from the current flat-rate system. Flat-rate service should be provided as an option for consumers, but only in such a way that low-volume users do not subsidize high-volume users.