Cost Of Surveillance Research Articles

Follow‐up: which one and for whom?

SummaryIn theory, surveillance of patients with uveal melanoma is aimed at detecting and treating ocular recurrence and morbidity as well as systemic metastases. In practice, the scope of such follow‐up is uncertain and controversial. Regular examination by an ocular oncologist can be difficult for patients who live far from the oncology center whereas inexpert ophthalmologists close to the patient's home may fail to detect tumor recurrence and other ocular morbidity in a timely manner. Screening for metastatic disease is expensive, can expose patients to harmful ionizing radiation, and only rarely seems to result in prolongation of life. Follow up protocols also have psychological impacts on patients, both positive and negative. There is scope for evidence‐based guidelines, which at present are lacking. The aims of this presentation are to consider the benefits and costs of ocular and systemic surveillance and to propose suggestions for personalized care.

Surveillance following surgery for nonmetastatic renal cell carcinoma.

Approximately one in three patients with nonmetastatic renal cell carcinoma (RCC) at the time of surgery will subsequently develop local or metastatic recurrence. The purpose of this review is to examine the current rationale for surveillance, describe sites of RCC metastasis, evaluate the existing guidelines for postsurgical follow-up studies, and analyze the risk stratification systems following RCC surgery. Although 75% of recurrences will be identified during the first 5 years following surgery, late recurrences are not uncommon. The risk of recurrence can be predicted from the tumor stage, grade, and other pathologic features. Advanced risk stratification will likely be possible in the future with increased use of molecular classification and serum biomarkers. Patient comorbidities, age, and individual recurrence risk should also be considered when designing individualized surveillance protocols. Follow-up after surgery for RCC should focus on imaging of the chest and abdomen to detect common sites of recurrence. Patients should be stratified for risk, and surveillance imaging should be more frequent and intensive in healthy patients with higher risk. Future research is needed to define an optimal individualized surveillance strategy that balances the potential benefits of early cancer detection with the risks and cost of surveillance.

CYR61 and TAZ Upregulation and Focal Epithelial to Mesenchymal Transition May Be Early Predictors of Barrett's Esophagus Malignant Progression.

Barrett’s esophagus is the major risk factor for esophageal adenocarcinoma. It has a low but non-neglectable risk, high surveillance costs and no reliable risk stratification markers. We sought to identify early biomarkers, predictive of Barrett’s malignant progression, using a meta-analysis approach on gene expression data. This in silico strategy was followed by experimental validation in a cohort of patients with extended follow up from the Instituto Português de Oncologia de Lisboa de Francisco Gentil EPE (Portugal). Bioinformatics and systems biology approaches singled out two candidate predictive markers for Barrett’s progression, CYR61 and TAZ. Although previously implicated in other malignancies and in epithelial-to-mesenchymal transition phenotypes, our experimental validation shows for the first time that CYR61 and TAZ have the potential to be predictive biomarkers for cancer progression. Experimental validation by reverse transcriptase quantitative PCR and immunohistochemistry confirmed the up-regulation of both genes in Barrett’s samples associated with high-grade dysplasia/adenocarcinoma. In our cohort CYR61 and TAZ up-regulation ranged from one to ten years prior to progression to adenocarcinoma in Barrett’s esophagus index samples. Finally, we found that CYR61 and TAZ over-expression is correlated with early focal signs of epithelial to mesenchymal transition. Our results highlight both CYR61 and TAZ genes as potential predictive biomarkers for stratification of the risk for development of adenocarcinoma and suggest a potential mechanistic route for Barrett’s esophagus neoplastic progression.

Predicting costs of alien species surveillance across varying transportation networks

Summary Efforts to detect and eradicate invading populations before they establish are a critical component of national biosecurity programmes. An essential element for maximizing the efficiency of these efforts is the balancing of expenditures on surveillance (e.g. trapping) versus treatment (e.g. eradication). Identifying the optimal allocation of resources towards surveillance requires an underlying model of how costs and the probability of detection fluctuate with survey intensity across various landscapes. Here, we develop a model, widely applicable across biological systems, for predicating costs associated with varying surveillance intensities across diverse road networks. We assumed that surveillance is conducted across a set of point locations. Resources needed to conduct surveillance include the fixed costs associated with surveying a point (e.g. cost of materials or labour time spent at the survey point) and variable costs that correspond to the expense of the time and distance travelled between points. We estimated travel time and distance between points as functions of surveillance intensity and road network characteristics using data from simulated least cost driving routes connecting points located on real‐world road networks. Time and distance estimates were then combined with cost data from an actual gypsy moth Lymantria dispar surveillance programme in the state of Washington to predict per trap costs of surveillance across varying road network densities and surveillance intensities. Per point driving time, driving distance and total costs all decline with increasing survey point density and increasing road density. Surveillance intensity (planned point spacing) explains ˜94% of the average time driven per point and 97% of the distance driven per point – thus representing the primary explanatory variable. Incorporating road density and dead end road density explains relatively little additional variance in the model, although they improve goodness of fit. Synthesis and applications. This work predicts costs associated with surveillance of invasive species populations. We find that the cost per survey point diminishes with increasing survey point density and also depends on road network characteristics. When combined with maps for the relative risk of alien species establishment across landscapes and measures of surveillance efficacy dependent on effort, these cost predictions can increase efficiency of surveillance and eradication efforts for the gypsy moth and other invasive species.

The Ethical Implications of the Reclassification of Noninvasive Follicular Variant Papillary Thyroid Carcinoma.

Several studies have highlighted the lack of consensus in the diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC). An international multidisciplinary panel to address the controversy was assembled at the annual meeting of the Endocrine Pathology Society in March of 2015, leading to the recent publication reclassifying encapsulated (or noninvasive) FVPTC (EFVPTC) as a benign neoplasm. Does this change in histologic taxonomy warrant a change in clinical practice, and how should it affect those who have been given this diagnosis in the past? We consider the financial and psychological impact of this reclassification and discuss the ethical, legal, and practical issues involved with sharing this information with the patients who are affected. The total direct and indirect cost of thyroid cancer surveillance in patients is significant. High levels of clinically relevant distress affect up to 43% of patients with papillary thyroid carcinoma, as estimated by the Distress Thermometer developed by the National Comprehensive Cancer Network for detecting distress in cancer patients. Although there are currently no legal opinions that establish a precedent for recontacting patients whose clinical status is altered by a change in nomenclature, the prudent course would be to attend to the requirements of medical ethics. Informing patients with a previous diagnosis of EFVPTC that the disease has been reclassified as benign is expected to have a dramatic effect on their surveillance needs and to alleviate the psychological impact of living with a diagnosis of cancer. It is important to re-evaluate the pathologic slides of those patients at risk to ensure that the invasive nature of the tumor is comprehensively evaluated before notifying a patient of a change in diagnosis. The availability of the entire tumor for evaluation of the capsule may prove to be a challenge for a portion of the population at risk. We believe that it is the clinician's professional duty to make a sincere and reasonable effort to convey the information to the affected patients. We also believe that the cost savings with respect to the need for additional surgery, radioactive iodine, and rigorous surveillance associated with a misinterpretation of the biology of the diagnosis of EFVPTC in less experienced hands will likely more than offset the cost incurred in histologic review and patient notification.

Use of CA-125 Tests and Computed Tomographic Scans for Surveillance in Ovarian Cancer

ImportanceA 2009 randomized clinical trial demonstrated that using cancer antigen 125 (CA-125) tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patients’ quality of life without improving survival, compared with clinical observation. The Society of Gynecologic Oncology guidelines categorize CA-125 testing as optional and discourage the use of radiographic imaging for routine surveillance. To date, few studies have examined the use of CA-125 tests in clinical practice.ObjectivesTo examine the use of CA-125 tests and computed tomographic (CT) scans in clinical practice before and after the 2009 randomized clinical trial and to estimate the economic effect of surveillance testing.Design, Setting, and ParticipantsA prospective cohort of 1241 women with ovarian cancer in clinical remission after completion of primary cytoreductive surgery and chemotherapy at 6 National Cancer Institute–designated cancer centers between January 1, 2004, and December 31, 2011, was followed up through December 31, 2012, to study the use of CA-125 tests and CT scans before and after 2009. Data analysis was conducted from April 9, 2014, to March 28, 2016.Main Outcomes and MeasuresThe use of CA-125 tests and CT scans before and after 2009. Secondary outcomes included the time from CA-125 markers doubling to retreatment among women who experienced a rise in CA-125 markers before and after 2009, and the costs associated with surveillance testing using 2015 Medicare reimbursement rates.ResultsAmong 1241 women (mean [SD] age 59 [12] years; 1112 white [89.6%]), the use of CA-125 testing and CT scans was similar during the study period. During 12 months of surveillance, the cumulative incidence of patients undergoing 3 or more CA-125 tests was 86% in 2004-2009 vs 91% in 2010-2012 (P = .95), and the cumulative incidence of patients undergoing more than 1 CT scan was 81% in 2004-2009 vs 78% in 2010-2012 (P = .50). Among women whose CA-125 markers doubled (n = 511), there was no significant difference in the time to retreatment with chemotherapy before and after 2009 (median, 2.8 vs 3.5 months; P = .40). During a 12-month period, there was a mean of 4.6 CA-125 tests and 1.7 CT scans performed per patient, resulting in a US population surveillance cost estimate of $1 999 029 per year for CA-125 tests alone and $16 194 647 per year with CT scans added.Conclusions and RelevanceCA-125 tests and CT scans are still routinely used for surveillance testing in patients with ovarian cancer, although their benefit has not been proven and their use may have significant implications for patients’ quality of life as well as costs.

Active surveillance cost effective for first-line HAART in Namibia

Active surveillance cost effective for first-line HAART in Namibia

Assessing Commitment and Reporting Fidelity to a Text Message-Based Participatory Surveillance in Rural Western Uganda.

Syndromic surveillance, the collection of symptom data from individuals prior to or in the absence of diagnosis, is used throughout the developed world to provide rapid indications of outbreaks and unusual patterns of disease. However, the low cost of syndromic surveillance also makes it highly attractive for the developing world. We present a case study of electronic participatory syndromic surveillance, using participant-mobile phones in a rural region of Western Uganda, which has a high infectious disease burden, and frequent local and regional outbreaks. Our platform uses text messages to encode a suite of symptoms, their associated durations, and household disease burden, and we explore the ability of participants to correctly encode their symptoms, with an average of 75.2% of symptom reports correctly formatted between the second and 11th reporting timeslots. Concomitantly we identify divisions between participants able to rapidly adjust to this unusually participatory style of data collection, and those few for whom the study proved more challenging. We then perform analyses of the resulting syndromic time series, examining the clustering of symptoms by time and household to identify patterns such as a tendency towards the within-household sharing of respiratory illness.

Active surveillance cost effective for first-line HAART in Namibia

Active surveillance cost effective for first-line HAART in Namibia

PCN120 - Gene Expression Profile Testing in Uveal Melanoma: An Economic Model to Evaluate Resource use in the United States

Nearly 50% of all uveal melanoma patients will metastasize within five years, predominantly to the liver, despite only 4% presenting with metastatic disease at diagnosis. Early detection through surveillance thus becomes paramount. DecisionDx-UM is a validated prognostic gene expression profile test that categorizes a patient’s metastatic risk as low, medium or high, allowing them to be followed with a surveillance program of corresponding intensity and minimizing over- or under-treatment. A decision tree model was developed to assess the impact of DecisionDx-UM on resource utilization associated with metastatic surveillance. Surveillance costs (outpatient visits, liver function testing, and imaging) were compared for the previous framework in which all patients received high-intensity surveillance regimens, and the current scenario in which patients are tested with DecisionDx-UM and receive a low-, medium- or high-intensity regimen based on their individual risk. Regimens and model structure were based on literature review and US clinical practice; cost inputs were based on 2015 Medicare rates. The model assumes 2,500 diagnoses per year and survival rates for each risk group based on results of the first Cooperative Ocular Oncology Group study. Model predictions included cost savings and reduction in surveillance procedures. DecisionDx-UM was associated with a 50% reduction in the number of surveillance procedures performed at two years compared to the previous framework (21,907 procedures with DecisionDx-UM vs. 43,706 without), with an overall 63% reduction at five years (40,496 procedures with DecisionDx-UM vs. 109,266 without). Overall cost savings per patient was $2,121 with total cost savings of $18,205,902 at five years. Use of DecisionDx-UM has the potential to greatly reduce resource utilization in uveal melanoma, allowing clinicians to focus aggressive surveillance programs on high-risk patients most likely to benefit from these interventions while sparing low-risk patients. This can also result in meaningful cost savings for payers in the US.

Healthcare Cost of Over-Diagnosis of Low-Grade Dysplasia in Barrett's Esophagus.

Published reports have demonstrated that many Barrett's esophagus patients are over-diagnosed as low-grade dysplasia (BE-LGD). We performed an analysis of the surveillance and treatment costs associated with the over-diagnosis of BE-LGD. As the principal cost variables, we used endoscopic and histologic procedures performed during the recommended surveillance intervals for patients with BE-LGD, the national average Medicare reimbursement for the Current Procedural Terminology codes of the procedures performed, and a spreadsheet-based tool we created to determine the overall healthcare cost associated with the over-diagnosis of BE-LGD in the US population. The average excess cost (range) for every patient in the US who is over-diagnosed with BE-LGD is estimated to be $5557 ($3115 to $8072). The principal contributors to the excess cost of over-diagnosis of BE-LGD in these patients are: endoscopy ($2626 to $4639), pathologist biopsy review ($275 to $2185), and esophagogastroduodenoscopy-guided endoscopic ablation ($214 to $1249). The healthcare cost of over-diagnosis of BE-LGD is significant. To reduce the overall healthcare cost impact of over-diagnosis of BE-LGD, strict adherence to the recommendations of the American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy that pathology review of all BE biopsy specimens be performed by a gastrointestinal pathologist is warranted.

Policy Statement on the Incarceration of Undocumented Migrant Families: Society for Community Research and Action Division 27 of the American Psychological Association.

Policy Statement on the Incarceration of Undocumented Migrant Families: Society for Community Research and Action Division 27 of the American Psychological Association.

Effect of asymptomatic recurrence detection after nephroureterectomy on prognosis in patients with upper urinary tract urothelial carcinoma.

364 Background: It is unknown whether routine follow up with body computed tomography (CT) to detect asymptomatic visceral recurrence after nephroureterectomy improves patient survival. We accessed the impact of follow up with body CT on patient survival after nephroureterectomy. Methods: A total 212 nephroureterectomy for upper urinary tract urothelial carcinoma were performed at our hospital between Feb 1995 and Oct 2015. All patients had regular follow up with chest x-ray, urine cytology and cystoscopy every 3 to 6 months, blood biochemical test, and CT of the chest and abdomen every 6 to 12 months. Additional examinations were required for symptomatic recurrence. We investigated the first site and date of tumor recurrence. Overall survival in patients with recurrence stratified by the mode of diagnosis (asymptomatic vs. symptomatic) was estimated using the Kaplan-Meier methods and compared with the log rank test. Cox proportional hazard regression models were used to evaluate the impact of the mode of diagnosing recurrence on survival. Results: A total 43 patients (20%) experienced recurrence after surgery, of whom 31 (72%) were asymptomatic and 12 (28%) were symptomatic. The most common symptoms at recurrence were pain in 7, hematuria in 2 , appetite loss in 1 , edema in 1 , palpable mass in 1, general malaise in 1 patients. Overall survival was not significantly different between in patients with asymptomatic vs. symptomatic recurrence; however, survival after tumor recurrence were better in patients with asymptomatic recurrence (P = 0.033). Moreover, multivariate analysis showed symptomatic recurrence was selected as a risk factor for overall survival after recurrence. Conclusions: Routine oncological follow up after nephroureterectomy for early detection of asymptomatic visceral recurrence was associated with patient survival. Further study is necessary to establish the optimal follow up regimen balancing the benefit of asymptomatic detection with the increased cost of routine surveillance.

A modelling framework for predicting the optimal balance between control and surveillance effort in the local eradication of tuberculosis in New Zealand wildlife

Bovine tuberculosis (TB) impacts livestock farming in New Zealand, where the introduced marsupial brushtail possum (Trichosurus vulpecula) is the wildlife maintenance host for Mycobacterium bovis. New Zealand has implemented a campaign to control TB using a co-ordinated programme of livestock diagnostic testing and large-scale culling of possums, with the long-term aim of TB eradication. For management of the disease in wildlife, methods that can optimise the balance between control and surveillance effort will facilitate the objective of eradication on a fixed or limited budget. We modelled and compared management options to optimise the balance between the two activities necessary to achieve and verify eradication of TB from New Zealand wildlife: the number of lethal population control operations required to halt the M. bovis infection cycle in possums, and the subsequent surveillance effort needed to confidently declare TB freedom post-control. The approach considered the costs of control and surveillance, as well as the potential costs of re-control resulting from false declaration of TB freedom. The required years of surveillance decreased with increasing numbers of possum lethal control operations but the overall time to declare TB freedom depended on additional factors, such as the probability of freedom from disease after control and the probability of success of mop-up control, i.e. retroactive culling following detection of persistent disease in the residual possum population. The total expected cost was also dependent on a number of factors, many of which had wide cost ranges, suggesting that an optimal strategy is unlikely to be singular and fixed, but will likely vary for each different area being considered. Our approach provides a simple framework that considers the known and potential costs of possum control and TB surveillance, enabling managers to optimise the balance between these two activities to achieve and prove eradication of a wildlife disease, or the pest species that transmits it, in the most expedient and economic way. This cost- and risk-evaluation approach may be applicable to other wildlife disease problems where limited management funds exist.

Strategies and approaches to vector control in nine malaria-eliminating countries: a cross-case study analysis.

BackgroundThere has been progress towards malaria elimination in the last decade. In response, WHO launched the Global Technical Strategy (GTS), in which vector surveillance and control play important roles. Country experiences in the Eliminating Malaria Case Study Series were reviewed to identify success factors on the road to elimination using a cross-case study analytic approach.MethodsReports were included in the analysis if final English language draft reports or publications were available at the time of analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for vector control in malaria elimination was developed, reviewed, formatted as a matrix, and case study data was extracted and entered into the matrix. A workshop was convened during which participants conducted reviews of the case studies and matrices and arrived at a consensus on the evidence and lessons. The framework was revised and a second round of data extraction, synthesis and summary of the case study reports was conducted.ResultsCountries implemented a range of vector control interventions. Most countries aligned with integrated vector management, however its impact was not well articulated. All programmes conducted entomological surveillance, but the response (i.e., stratification and targeting of interventions, outbreak forecasting and strategy) was limited or not described. Indoor residual spraying (IRS) was commonly used by countries. There were several examples of severe reductions or halting of IRS coverage and subsequent resurgence of malaria. Funding and operational constraints and poor implementation had roles. Bed nets were commonly used by most programmes; coverage and effectiveness were either not measured or not articulated. Larval control was an important intervention for several countries, preventing re-introduction, however coverage and impact on incidence were not described. Across all interventions, coverage indicators were incomparable, and the rationale for which tools were used and which were not used appeared to be a function of the availability of funding, operational issues and cost instead of evidence of effectiveness to reduce incidence.ConclusionsMore work is required to fill gaps in programme guidance, clarify the best methods for choosing and targeting vector control interventions, and support to measure cost, cost-effectiveness and cost-benefit of vector surveillance and control interventions.

The Long-Term Costs of Government Surveillance: Insights from Stasi Spying in East Germany

Despite the prevalence of government surveillance systems around the world, causal evidence on their social and economic consequences is lacking. Using county-level variation in the number of Stasi informers within Socialist East Germany during the 1980s and accounting for potential endogeneity, we show that more intense regional surveillance led to lower levels of trust and reduced social activity in post-reunification Germany. We also find substantial and long-lasting economic effects of Stasi spying, resulting in lower self-employment, higher unemployment and larger out-migration throughout the 1990s and 2000s. We further show that these effects are due to surveillance and not alternative mechanisms. We argue that our findings have important implications for contemporary surveillance systems.

The Long-Term Costs of Government Surveillance: Insights from Stasi Spying in East Germany

Despite the prevalence of government surveillance systems around the world, causal evidence on their social and economic consequences is lacking. Using county-level variation in the number of Stasi informers within Socialist East Germany during the 1980s and accounting for potential endogeneity, we show that more intense regional surveillance led to lower levels of trust and reduced social activity in post-reunification Germany. We also find substantial and long-lasting economic effects of Stasi spying, resulting in lower self-employment, higher unemployment and larger out-migration throughout the 1990s and 2000s. We further show that these effects are due to surveillance and not alternative mechanisms. We argue that our findings have important implications for contemporary surveillance systems.

Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score.

Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/ nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit. Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with National Comprehensive Cancer Network very low-risk and low-risk cancer led to a substantial increase in uptake of active surveillance and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making.

Surveillance in Patients With Barrett's Esophagus for Early Detection of Esophageal Adenocarcinoma: A Systematic Review and Meta-Analysis.

Objectives:Although endoscopic surveillance of patients with Barrett's esophagus (BE) has been widely implemented for early detection of esophageal adenocarcinoma (EAC), its justification has been debated. This systematic review aimed to evaluate benefits, safety, and cost effectiveness of surveillance for patients with BE.Methods:MEDLINE, EMBASE, EconLit, Scopus, Cochrane, and CINAHL were searched for published human studies that examined screening practices, benefits, safety, and cost effectiveness of surveillance among patients with BE. Reviewers independently reviewed eligible full-text study articles and conducted data extraction and quality assessment, with disagreements resolved by consensus. Random effects meta-analyses were performed to assess the incidence of EAC, EAC/high-grade dysplasia (HGD), and annual stage-specific transition probabilities detected among BE patients under surveillance, and relative risk of mortality among EAC patients detected during surveillance compared with those not under surveillance.Results:A total of 51 studies with 11,028 subjects were eligible; the majority were of high quality based on the Newcastle–Ottawa quality scale. Among BE patients undergoing endoscopic surveillance, pooled EAC incidence per 1,000 person-years of surveillance follow-up was 5.5 (95% confidence interval (CI): 4.2–6.8) and pooled EAC/HGD incidence was 7.7 (95% CI: 5.7–9.7). Pooled relative mortality risk among surveillance-detected EAC patients compared with nonsurveillance-detected EAC patients was 0.386 (95% CI: 0.242–0.617). Pooled annual stage-specific transition probabilities from nondysplastic BE to low-grade dysplasia, high-grade dysplasia, and EAC were 0.019, 0.003, and 0.004, respectively. There was, however, insufficient scientific evidence on safety and cost effectiveness of surveillance for BE patients.Conclusions:Our findings confirmed a low incidence rate of EAC among BE patients undergoing surveillance and a reduction in mortality by 61% among those who received regular surveillance and developed EAC. Because of knowledge gaps, it is important to assess safety of surveillance and health-care resource use and costs to supplement existing evidence and inform a future policy decision for surveillance programs.

Simulation of a classical swine fever outbreak in rural areas of the Republic of Serbia

Several different strategies for control and eradication of classical swine fever (CSF) were compared using a Monte Carlo method-based simulation model. The control strategy analysed in this paper, in addition to other CSF control measures, includes application of biosecurity measures on pig farms and rural backyard holdings. Elements of the control strategy are based on applicable regulations and include the simulation of detection of the disease, setting up the protected and surveillance zones, standstill of pig movements and restricted movement of animals, vehicles, equipment, and people with strong control measures in protection and surveillance zones, euthanasia of susceptible pigs, protective vaccination of pigs, compensation etc. During the simulation, different output parameters were compared such as: duration of epidemic of a disease, number of affected holdings and animals, direct costs such as those for dead or culled animals, costs of surveillance, disposal of infectious materials, cleaning and disinfection. Depopulation of affected animals with early diagnostics and vaccination in the protection and surveillance zone proved to be the most effective measures to stop the spread and for the eradication of the disease. Moreover, during the simulation, systematic implementation of biosecurity measures in all pig production clusters was demonstrated to be an appropriate strategy for sustainable control of CSF and the establishment of a stable epidemiological situation.