Under the Affordable Care Act, hospitals must pay a penalty for each hospital-acquired-infection (HAI) occurring within their in-patient population. As a result, if a patient dies from a superbug contracted during a procedure such as surgery, the official cause of death may be instead listed as “Complications from Surgery.” Consistent and systemic undercounting of illnesses and deaths from resistant infections further discourages the development of new antibiotics as the number of patients who need these medicines may appear to be very small.
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[W]hen a new antibiotic becomes available, it should only be used as a last resort to prevent new resistance from arising. This kind of responsible use is a good thing! But stewardship severely limits the number of patients who will receive a new antibiotic and, correspondingly, the potential sales volume.
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Insurers pay for in-patient antibiotics as part of a lump sum to hospitals known as a Diagnosis Related Group (DRG). Using a cheap antibiotic increases hospital profit margins, while using an expensive new drug could mean that a hospital might lose money by treating a given patient. As a result, hospitals are incentivized to use cheaper antibiotics whenever possible. This puts significant pricing pressure on new antibiotics, which are one of the only type of medicines paid for like this.
If anything I think this is proof that the free market will fail certain needs and that government funded research and supplementation of drug production cost is necessary. We've seen similar...
If anything I think this is proof that the free market will fail certain needs and that government funded research and supplementation of drug production cost is necessary.
We've seen similar issues lately with other drugs that are important for certain individuals but do not have the greatest financial incentives behind them (recent examples being epi pens and certain types of insulin).
Tangential, but one thing I wanted to point out because it often gets overlooked when we talk about antibiotic drugs - everything else that can be antibiotic. For example, materials such as copper...
Tangential, but one thing I wanted to point out because it often gets overlooked when we talk about antibiotic drugs - everything else that can be antibiotic.
For example, materials such as copper can be used to reduce the rate and transmission of infections in a hospital environment. An effective HVAC system combined with UV (both in the HVAC and for UV washing of surgical materials and rooms) can also help reduce transmission of bacteria.
While antibiotic development is absolutely a key part of treating individuals who do acquire complex bacterial infections, there are many other methods we should investigate to reduce hospital acquired infections.
One other important thing to note, is that better antibiotics may not even be needed. In recent years we've been discovering other non-antibiotic chemicals can have antibiotic properties or may even enhance the effectiveness of antibiotics when combined with them. Chemicals which might weaken the bacterial cell wall, for example, or open channels that did not previous exist may be able to be combined with certain antibiotics to treat resistant bacteria.
You know who should be funding this drug development in the current U.S. marketplace? Private insurance companies. The relative costs of rescuing a patient with a resistant bug running rampant are...
You know who should be funding this drug development in the current U.S. marketplace? Private insurance companies.
The relative costs of rescuing a patient with a resistant bug running rampant are enormous. There are often hospital ICU days at $10,000/day. Failed and repeated surgeries, infected implants, organ failures and transplants... As it happens, my brother is currently recovering from the second surgical attempt to save his thumb, after he got a literal pinprick infected with bacteria that laughed at Keflex and ofloxacin.
You'd think a bright actuary would run the numbers and say, "We need first-line antibiotics that work again!"
Infection control, improved bacteriostatic materials, and better handling of existing antibiotics are all needed. But something's always going to out-evolve the existing suite of tools, and humans are a very tasty ecological niche.
Obviously, the U.S. healthcare marketplace, and venture capital/public stocks, and even Gates Foundation seed money are lousy ways to handle existential threats to the entire human species. I know other countries are funding everything from bacteriophage treatments to mycology, but this really calls for better global coordination.
Edit - more info:
U.S. Centers for Disease Control estimates current antibiotic resistance incidence and associated mortality/morbidity as follows:
More than 2.8 million antibiotic-resistant infections occur in the United States each year, and
more than 35,000 people die as a result. In addition, nearly 223,900 people in the United
States required hospital care for C. difficile and at least 12,800 people died in 2017.
It should definitely be worthwhile for insurers to invest. Though the estimated additional treatment costs I've seen are only an extra $1,400/patient, or $2 billion/year, that seems quite conservative.
[The whole CDC PDF document here is worth reading if you want to take a deep dive on antibiotic resistance threats.]
From the article:
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[...]
If anything I think this is proof that the free market will fail certain needs and that government funded research and supplementation of drug production cost is necessary.
We've seen similar issues lately with other drugs that are important for certain individuals but do not have the greatest financial incentives behind them (recent examples being epi pens and certain types of insulin).
Tangential, but one thing I wanted to point out because it often gets overlooked when we talk about antibiotic drugs - everything else that can be antibiotic.
For example, materials such as copper can be used to reduce the rate and transmission of infections in a hospital environment. An effective HVAC system combined with UV (both in the HVAC and for UV washing of surgical materials and rooms) can also help reduce transmission of bacteria.
While antibiotic development is absolutely a key part of treating individuals who do acquire complex bacterial infections, there are many other methods we should investigate to reduce hospital acquired infections.
One other important thing to note, is that better antibiotics may not even be needed. In recent years we've been discovering other non-antibiotic chemicals can have antibiotic properties or may even enhance the effectiveness of antibiotics when combined with them. Chemicals which might weaken the bacterial cell wall, for example, or open channels that did not previous exist may be able to be combined with certain antibiotics to treat resistant bacteria.
You know who should be funding this drug development in the current U.S. marketplace? Private insurance companies.
The relative costs of rescuing a patient with a resistant bug running rampant are enormous. There are often hospital ICU days at $10,000/day. Failed and repeated surgeries, infected implants, organ failures and transplants... As it happens, my brother is currently recovering from the second surgical attempt to save his thumb, after he got a literal pinprick infected with bacteria that laughed at Keflex and ofloxacin.
You'd think a bright actuary would run the numbers and say, "We need first-line antibiotics that work again!"
Infection control, improved bacteriostatic materials, and better handling of existing antibiotics are all needed. But something's always going to out-evolve the existing suite of tools, and humans are a very tasty ecological niche.
Obviously, the U.S. healthcare marketplace, and venture capital/public stocks, and even Gates Foundation seed money are lousy ways to handle existential threats to the entire human species. I know other countries are funding everything from bacteriophage treatments to mycology, but this really calls for better global coordination.
Edit - more info:
U.S. Centers for Disease Control estimates current antibiotic resistance incidence and associated mortality/morbidity as follows:
More than 2.8 million antibiotic-resistant infections occur in the United States each year, and
more than 35,000 people die as a result. In addition, nearly 223,900 people in the United
States required hospital care for C. difficile and at least 12,800 people died in 2017.
It should definitely be worthwhile for insurers to invest. Though the estimated additional treatment costs I've seen are only an extra $1,400/patient, or $2 billion/year, that seems quite conservative.
[The whole CDC PDF document here is worth reading if you want to take a deep dive on antibiotic resistance threats.]