Cost Of Surveillance Research Articles

To pool or not to pool? Guidelines for pooling samples for use in surveillance testing of infectious diseases in aquatic animals.

Samples from multiple animals may be pooled and tested to reduce costs of surveillance for infectious agents in aquatic animal populations. The primary advantage of pooling is increased population-level coverage when prevalence is low (<10%) and the number of tests is fixed, because of increased likelihood of including target analyte from at least one infected animal in a tested pool. Important questions and a priori design considerations need to be addressed. Unfortunately, pooling recommendations in disease-specific chapters of the 2018 OIE Aquatic Manual are incomplete and, except for amphibian chytrid fungus, are not supported by peer-reviewed research. A systematic review identified only 12 peer-reviewed aquatic diagnostic accuracy and surveillance studies using pooled samples. No clear patterns for pooling methods and characteristics were evident across reviewed studies, although most authors agreed there is a negative effect on detection. Therefore, our purpose was to review pooling procedures used in published aquatic infectious disease research, present evidence-based guidelines, and provide simulated data examples for white spot syndrome virus in shrimp. A decision tree of pooling guidelines was developed for use by peer-reviewed journals and research institutions for the design, statistical analysis and reporting of comparative accuracy studies of individual and pooled tests for surveillance purposes.

449 Cost-Effectiveness of Adjunctive Wide Area Transepithelial Sampling With Computer-Assisted Analysis in Screening for Barrett’s Esophagus

INTRODUCTION: Screening for Barrett’s Esophagus (BE) in chronic gastroesophageal reflux disease (GERD) using targeted and random forceps biopsy (FB) is recommended by current ACG guidelines. A recent study of 10,412 screening patients showed that Wide Area Transepithelial Sampling with 3D computer-assisted tissue analysis (WATS) increases detection of Barrett’s esophagus (BE) when used adjunctively to FB. We analyzed the cost-effectiveness implications of this study’s findings. METHODS: A decision analytic model compared the effectiveness and cost-effectiveness of two alternative screening strategies for BE in chronic GERD patients: FB alone vs. FB combined with WATS. The reference case was a 60 year old male. BE detected by positive FB or WATS was referred for surveillance. False positive WATS+/FB- were confirmed after a second negative surveillance FB. Cost and effectiveness of surveillance were based on published models with ablation for low or high grade dysplasia, available on the National Cancer Institute CISNET website. See Table 1 for an overview of model parameters. Effectiveness was measured in quality-adjusted life years (QALYs). Cost was measured in 2018 US$ and the incremental cost-effectiveness ratio (ICER) was measured in $/QALY. Model parameters are outlined in Table 2. We considered 3 values of added yield (213% from the study, half of that, one-third of that) and 3 values of false positives among the added yield (5%, 15%, 25%) and calculated the ICER for all 9 pairwise combinations of those two parameters. We considered two thresholds for cost-effectiveness: $100K/QALY and $150K/QALY. Cost and QALYs were discounted at 3% per year. RESULTS: The ICERs for all 9 combinations of added yield and false positives are in Table 3. Use of FB plus WATS was cost-effective in all 9 combinations at the lower $100K/QALY threshold. Using the worst case for added yield (1/3 of the value from the study), FB plus WATS was cost-effective at the $150K/QALY for a false positive rate below 56%. Using the worst case for false positive rate (25%), FB plus WATS was cost-effective at the $150K/QALY for added yield of over 38%. CONCLUSION: We demonstrate that WATS, when used adjunctively with FB for screening 60 year old males with chronic GERD, is a cost-effective approach to reducing morbidity and mortality from esophageal cancer.

Low Risk Thyroid Cancer in Older Adults: More Extensive Surgery Comes with Increased Cost of Surveillance

Zambeli-Ljepovic, Alan BS; Wang, Frances MS; Dinan, Michaela A. PhD; Hyslop, Terry PhD; Stang, Michael T. MD, FACS; Roman, Sanziana A. MD, FACS; Sosa, Julie Ann MD, MA, FACS; Scheri, Randall P. MD, MA, FACS Author Information

Projection of Costs of Polio Eradication Compared to Permanent Control.

Despite increased efforts and spending toward polio eradication, it has yet to be eliminated worldwide. We aimed to project economic costs of polio eradication compared to permanent control. We used historical Financial Resource Requirements from the Global Polio Eradication Initiative, as well as vaccination and population data from publicly available sources, to project costs for routine immunization, immunization campaigns, surveillance and laboratory resources, technical assistance, social mobilization, treatment, and overhead. We found that cumulative spending for a control strategy would exceed that for an eradication strategy in 2032 (range, 2027-2051). Eradication of polio would likely be cost-saving compared to permanent control.

High-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas

Surveillance of patients with colorectal adenomas has limited long-term evidence to support current practice. To compare the lifetime benefits and costs of high- versus low-intensity surveillance. Microsimulation model. U.S. cancer registry, cost data, and published literature. U.S. patients aged 50, 60, or 70 years with low-risk adenomas (LRAs) (1 to 2 small adenomas) or high-risk adenomas (HRAs) (3 to 10 small adenomas or ≥1 large adenoma) removed after screening with colonoscopy or fecal immunochemical testing (FIT). Lifetime. Societal. No further screening or surveillance, routine screening after 10 years, low-intensity surveillance (10 years after LRA removal and 5 years after HRA removal), and high-intensity surveillance (5 years after LRA removal and 3 years after HRA removal). Colorectal cancer (CRC) incidence and incremental cost-effectiveness. Without surveillance or screening, lifetime CRC incidence for patients aged 50 years was 10.9% after LRA removal and 17.2% after HRA removal at screening colonoscopy. Subsequent colonoscopic screening, low-intensity surveillance, or high-intensity surveillance decreased incidence by 39%, 46% to 48%, and 55% to 56%, respectively. Incidence of CRC and surveillance benefits were higher for adenomas detected at FIT screening and lower for older patients. High-intensity surveillance cost less than $30000 per quality-adjusted life-year (QALY) gained compared with low-intensity surveillance. High-intensity surveillance cost less than $100000 per QALY gained in most alternative scenarios for adenoma recurrence, CRC incidence, longevity, quality of life, screening ages, surveillance ages, test performance, disutilities, and cost. Few surveillance outcome data exist. The model suggests that high-intensity surveillance as recommended in the United States provides modest but clinically relevant benefits over low-intensity surveillance at acceptable cost. National Cancer Institute.

Surgery alone for papillary thyroid microcarcinoma is less costly and more effective than long term active surveillance

BackgroundPapillary thyroid microcarcinoma is a subtype of thyroid cancer that may be managed with active surveillance rather than immediate surgery. Active surveillance decreases complication rates and may decrease health care costs. This study aims to analyze complication rates of thyroid surgery, papillary thyroid microcarcinoma recurrence, and survival rates. Additionally, the costs of surgery versus hypothetic active surveillance for papillary thyroid microcarcinoma are compared in an Australian cohort. MethodsPapillary thyroid microcarcinoma patients were included from a prospectively collected surgical cohort of patients treated for papillary thyroid cancer between 1985 and 2017. The primary outcomes were the complications of thyroid surgery, recurrence-free survival, overall survival, and cost of surgical treatment and active surveillance. ResultsIn a total of 349 patients with papillary microcarcinoma with a median age of 48 years (range, 18–90 years), the permanent operative complications rate was 3.7%. Postoperative radioactive iodine did not decrease recurrence-free survival (P = .3). The total cost of surgical treatment was $10,226 Australian dollars, whereas hypothetic active surveillance was at a yearly cost of $756 Australian dollars. Estimated cost of surgical papillary thyroid microcarcinoma treatment was equivalent to the cost of 16.2 years of active surveillance. ConclusionSurgery may have a long-term economic advantage for younger Australian patients with papillary thyroid microcarcinoma who are likely to require more than 16.2 years of follow-up in an active surveillance scheme.

Wanting it all – public perceptions of the effectiveness, cost, and privacy of surveillance technology

PurposeThis study aims to explore how the public perceives the effectiveness of surveillance technology, and how people’s views on privacy and their views on effectiveness are related. Likewise, it looks at the relation between perceptions of effectiveness and opinions on the acceptable cost of surveillance technology.Design/methodology/approachFor this study, surveys of Dutch students and their parents were conducted over three consecutive years.FindingsA key finding of this paper is that the public does not engage in a trade-off neither with regard to privacy-effectiveness (exchanging more effectiveness for less privacy and vice versa) nor with effectiveness-cost, but rather expects all three elements to be achieved simultaneously. This paper also found that the correlation between perceived effectiveness and perceived privacy was stronger for parents than for students.Research limitations/implicationsParticipants for this study were exclusively in The Netherlands. Survey questions on the effectiveness of surveillance technology focused on one type of technology, and on private mobile device use in two scenarios.Social implicationsThe public’s perceptions of the effectiveness of surveillance technology potentially influence its acceptance of the technology, which, in turn, can affect the legitimacy and use of the technology.Originality/valueWithin the much-discussed privacy-security debate lies a less-heard debate – that of the effectiveness of the surveillance technology in question. The public is one actor in this debate. This study examines the public’s perceptions of this less-heard debate.

Leveraging the Global Influenza Surveillance and Response System for global respiratory syncytial virus surveillance-opportunities and challenges.

BackgroundRespiratory syncytial virus (RSV)‐associated acute lower respiratory infection is a common cause for hospitalization and hospital deaths in young children globally. There is urgent need to generate evidence to inform immunization policies when RSV vaccines become available. The WHO piloted a RSV surveillance strategy that leverages the existing capacities of the Global Influenza Surveillance and Response System (GISRS) to better understand RSV seasonality, high‐risk groups, validate case definitions, and develop laboratory and surveillance standards for RSV.MethodsThe RSV sentinel surveillance strategy was piloted in 14 countries. Patients across all age groups presenting to sentinel hospitals and clinics were screened all year‐round using extended severe acute respiratory infection (SARI) and acute respiratory infection (ARI) case definitions for hospital and primary care settings, respectively. Respiratory specimens were tested for RSV at the National Influenza Centre (NIC) using standardized molecular diagnostics that had been validated by an External Quality Assurance program. The WHO FluMart data platform was adapted to receive case‐based RSV data and visualize interactive visualization outputs.ResultsLaboratory standards for detecting RSV by RT‐PCR were developed. A review assessed the feasibility and the low incremental costs for RSV surveillance. Several challenges were addressed related to case definitions, sampling strategies, the need to focus surveillance on young children, and the data required for burden estimation.ConclusionsThere was no evidence of any significant adverse impact on the functioning of GISRS which is primarily intended for virologic and epidemiological surveillance of influenza.

Cost analysis of screening methods to find non-compliant models using the example of tumble dryers

The European energy label was established to reduce energy consumption in Europe. All classes and values on the energy label are stated by the supplier. The task of market surveillance is to ensure correct labels and to validate their values through compliance tests. However, this can only be done for a small fraction of all models on the market, since physical tests are expensive. Screening methods can be used to narrow down the number of critical products before compliance tests are done to decrease the costs of finding non-compliant models. This study shows a mathematical approach to analyze the cost benefits of screening methods to find non-compliant models. Furthermore, the analysis presented has been applied to 18 screening methods for tumble dryers. The performance test for tumble dryers consists of seven test runs. All screening methods evaluated are composed of a reduced number of test runs. The most efficient screening method reduces the surveillance costs by 40%.

“You Don’t Need Nobody Else Knocking you Down”: Survivor-Mothers’ Experiences of Surveillance in Domestic Violence Shelters

For survivors of intimate partner violence (IPV), the act of seeking help from a domestic violence (DV) shelter can incur enormous costs. One cost is what we refer to as “parenting surveillance:” that is, DV advocates can monitor, evaluate, and sometimes control survivors’ parenting—activities given weight through their mandated reporter role. Although surveillance has long been a feature of state intervention into family life, particularly for low-income women of color, it is largely unexplored in the DV shelter system. This is a striking gap: Though most DV programs are committed to supporting survivors’ autonomy and empowerment, the surveillance of parenting may echo abusive dynamics from which survivors are attempting to escape. This qualitative-descriptive study aimed to explore survivor-mothers’ experiences of parenting surveillance among 12 residents of four shelters. Qualitative content analysis yielded five clusters: Survivor-mothers (1) experience and witness parenting surveillance in their programs even as they also find support, (2) describe negative psychological responses to surveillance, (3) report effects on parenting from surveillance, (4) cope with and resist surveillance, and (5) offer recommendations that minimize or diminish surveillance. Although surveillance is a structural phenomenon, baked into the policies and practices of DV shelters, participants’ experiences of it vary based on their personal identities and histories and their relationships with advocates. Despite these variations, however, the costs of surveillance for mothers is significant. For advocates, addressing this phenomenon requires pragmatic and relational shifts grounded in empathy for survivor-mothers’ subjective experience of parenting in challenging conditions.

Highly-Secure Backdoors: Internet of Traitorous Things (IoTT)

Highly-Secure Backdoors: Internet of Traitorous Things (IoTT)

Health and Economic Impact of Intensive Surveillance for Distant Recurrence After Curative Treatment of Colon Cancer: A Mathematical Modeling Study.

Intensive surveillance strategies are currently recommended for patients after curative treatment of colon cancer, with the aim of secondary prevention of recurrence. Yet, intensive surveillance has not yielded improvements in overall patient survival compared with minimal follow-up, and more intensive surveillance may be costlier. The purpose of this study was to estimate the quality-adjusted life-years, economic costs, and cost-effectiveness of various surveillance strategies after curative treatment of colon cancer. A Markov model was calibrated to reflect the natural history of colon cancer recurrence and used to estimate surveillance costs and outcomes. This was a decision-analytic model. Individuals entered the model at age 60 years after curative treatment for stage I, II, or III colon cancer. Other initial age groups were assessed in secondary analyses. We estimated the gains in quality-adjusted life-years achieved by early detection and treatment of recurrence, as well as the economic costs of surveillance under various strategies. Cost-effective strategies for patients with stage I colon cancer improved quality-adjusted life-expectancy by 0.02 to 0.06 quality-adjusted life-years at an incremental cost of $1702 to $13,019. For stage II, they improved quality-adjusted life expectancy by 0.03 to 0.09 quality-adjusted life-years at a cost of $2300 to $14,363. For stage III, they improved quality-adjusted life expectancy by 0.03 to 0.17 quality-adjusted life-years for a cost of $1416 to $17,631. At a commonly cited willingness-to-pay threshold of $100,000 per quality-adjusted life-year, the most cost-effective strategy for patients with a history of stage I or II colon cancer was liver ultrasound and chest x-ray annually. For those with a history of stage III colon cancer, the optimal strategy was liver ultrasound and chest x-ray every 6 months with CEA measurement every 6 months. The study was limited by model structure assumptions and uncertainty around the values of the model's parameters. Given currently available data and within the limitations of a model-based decision-analytic approach, the effectiveness of routine intensive surveillance for patients after treatment of colon cancer appears, on average, to be small. Compared with testing using lower cost imaging, currently recommended strategies are associated with cost-effectiveness ratios that indicate low value according to well-accepted willingness-to-pay thresholds in the United States. See Video Abstract at http://links.lww.com/DCR/A921.

What is the opportunity cost of postmolar surveillance for women of advanced maternal age seeking pregnancy? A Monte Carlo microsimulation model

Objective: Age is associated with both gestational trophoblastic disease (GTD) and natural decline in fertility. Guidelines recommend 6 months surveillance after beta-hCG normalization. However, the gestational trophoblastic neoplasia (GTN) risk after normalization is very low. Our goal is to examine the opportunity cost of postmolar surveillance in terms of fertility outcomes for women of advanced maternal age (AMA).

Comparing Cerebral Palsy Surveillance Definition to ICD Codes and Written Diagnoses

Comparing Cerebral Palsy Surveillance Definition to ICD Codes and Written Diagnoses

RS04. Ultrasound Surveillance Following Carotid Endarterectomy: Prudent or Pointless?

To assess the usefulness of routine duplex ultrasound (DUS) surveillance following carotid endarterectomy (CEA) with respect to rates, outcomes, and management of carotid restenosis, and to outline the natural history of carotids after CEA. This is a cohort study of patients who underwent CEA at The Ottawa Hospital (TOH) from 2003 to 2018. DUS was completed at TOH's accredited Vascular Diagnostic Center as per protocol (currently performed at 3 and 12 months postoperatively and yearly thereafter). Follow-up DUS and clinical data were obtained from Vascubase and electronic medical records (vOacis). Primary outcomes included time to more than 80% restenosis, post-CEA stroke rate, and number of surgical reinterventions. Statistical analyses involved survival analysis, χ2 and Fisher's exact tests, and a cost-effectiveness analysis. There were 1190 CEAs performed in 1129 patients over the study period. The majority were for symptomatic (78.0%) carotids ranging from 70% to 99% stenosis (93.3%). 769 surgeries (729 patients) had DUS surveillance data available for a mean of 3.52 years. DUS detected more than 80% ipsilateral restenosis in 31 patients (4.03%; Fig 1). There were 34 total postoperative strokes. Twenty-five (73.5%) occurred within 30 days of surgery—before the initial surveillance DUS—and 16 of those occurred within the first 24 hours. No stroke beyond 30 days was attributed to ipsilateral carotid restenosis (Fig 2). As per the TOH post-CEA protocol, the estimated cost of DUS surveillance in this cohort was $359,925.20 total, or $11,610.49 per restenosis. DUS surveillance did not lead to a single ipsilateral redo surgery during this period. Severe carotid restenosis after CEA is rare and not associated with worse outcomes. Despite historical recommendation, TOH's management of severe restenosis has been conservative based on its benign natural history. Routine post-CEA DUS surveillance is costly and unlikely to improve outcomes or affect management, even if more than 80% ipsilateral restenosis is detected. Further research should determine the usefulness of routine contralateral carotid DUS surveillance in this population, who may be at greater risk for severe contralateral carotid disease.Fig 2Stroke etiology for strokes detected beyond 30 days from carotid endarterectomy (CEA). Strokes were attributed to contralateral carotid stenosis/occlusion (n = 5), hypoperfusion (n = 3), and basilar artery occlusion (n = 1). Not a single stroke beyond 30 days was attributed to ipsilateral carotid restenosis. ICA, Internal carotid artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Overuse of Cystoscopic Surveillance Among Patients With Low-risk Non–Muscle-invasive Bladder Cancer – A National Study of Patient, Provider, and Facility Factors

To understand cystoscopic surveillance practices among patients with low-risk non-muscle-invasive bladder cancer (NMIBC) within the Department of Veterans Affairs (VA). Using a validated natural language processing algorithm, we included patients newly diagnosed with low-risk (ie low-grade Ta) NMIBC from 2005 to 2011 in the VA. Patients were followed until cancer recurrence, death, last contact, or 2 years after diagnosis. Based on guidelines, surveillance overuse was defined as >1 cystoscopy if followed <1 year, >2 cystoscopies if followed 1 to <2 years, or >3 cystoscopies if followed for 2 years. We identified patient, provider, and facility factors associated with overuse using multilevel logistic regression. Overuse occurred in 75% of patients (852/1135) - with an excess of 1846 more cystoscopies performed than recommended. Adjusting for 14 factors, overuse was associated with patient race (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.28, 0.85 unlisted race vs White), having 2 comorbidities (OR 1.60, 95% CI: 1.00, 2.55 vs no comorbidities), and earlier year of diagnosis (OR 2.50, 95% CI: 1.29, 4.83 for 2005 vs 2011, and OR 2.03, 95% CI: 1.11, 3.69 for 2006 vs 2011). On sensitivity analyses assuming all patients were diagnosed with multifocal or large low-grade tumors (ie, intermediate-risk), overuse would have still occurred in 45% of patients. Overuse of cystoscopy among patients with low-risk NMIBC was common, raising concerns about bladder cancer surveillance cost and quality. However, few factors were associated with overuse. Further qualitative research is needed to identify other determinants of overuse not readily captured in administrative data.

Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging.

BACKGROUNDPatients with pancreatic cystic neoplasms (PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime image-based surveillance follow-up. In these patients, the current European evidenced-based guidelines advise magnetic resonance imaging (MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound (US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US.AIMTo report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI.METHODSWe retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings. In this communication, we reported the clinical results of this alternative follow-up, and the results of a comparative cost-analysis between our surveillance protocol (abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol.RESULTSIn the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients (1%) because of the appearance of suspicious features at imaging (with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients (14%). These comprised main pancreatic duct dilatation (n = 1), increased size of the main cyst (n = 14) and increased number of PNC (n = 13). In all of these patients, MRI confirmed US findings, without adding more information. The bi-annual MRI identified evolution of the lesions not identified by US in only 11 patients with intraductal papillary mucinous neoplasms (5.5%), largely consisting of an increased number of very small PCN (P = 0.14). The overall mean cost of surveillance, based on a theoretical use of the European evidenced-based exclusive MRI surveillance in the same group of patients, would have been 1158.9 ± 798.6 € per patient, in contrast with a significantly lower cost of 366.4 ± 348.7 € (P < 0.0001) incurred by the US-restricted MRI surveillance used at our institution.CONCLUSIONIn patients with non-surgical PCN at the time of diagnosis, US surveillance could be a safe complementary approach to MRI, delaying and reducing the numbers of second level examinations and therefore reducing the costs.

Optimizing surveillance strategies for early detection of invasive alien species

Surveillance programs to detect alien invasive pests seek to find them as soon as possible, but also to minimize the cost of damage from invasion. To examine the trade-offs between these objectives, we developed an economic model that allocates survey sites to minimize either the expected mitigation costs or the expected time until first detection of an invasive alien pest subject to a budget constraint on surveillance costs. We also examined strategies preferred by ambiguity-averse decision makers that minimize the expected and worst-case outcomes of each performance measure. We applied the model to the problem of detecting Asian longhorned beetle (Anoplophora glabripennis) in the Greater Toronto Area, Canada, one of the most harmful invasive alien insects in North America. When minimizing expected mitigation costs or expected time to detection, the trade-off between these survey objectives was small. Strategies that minimize the worst-case mitigation costs differed sharply and surveyed sites with high host densities using high sampling intensities whereas strategies that minimize the worst detection times surveyed sites across the entire area using low sampling intensities. Our results suggest that preferences for minimizing mitigation costs or time to detection are more consequential for ambiguity-averse managers than they are for risk-neutral decision-makers.

Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction.

Hepatocellular cancer (HCC) is the fourth leading cause of cancer-related deaths worldwide and the fastest growing cause of cancer deaths in the United States. The overall prognosis of HCC remains dismal, except for the subset of patients who are diagnosed at early stage and receive potentially curative therapies, such as surgical resection and liver transplantation. Given this, expert society guidelines recommend HCC surveillance every 6 months in at-risk individuals. Despite these recommendations, the effectiveness of HCC surveillance remains a subject of debate. We discuss current best practices for HCC surveillance and the evidence that support these recommendations. We also describe several initiatives that are underway to improve HCC surveillance and outline areas that may serve as high-yield targets for future research. Overall, we believe these efforts will help the field move toward precision surveillance, where surveillance tests and intervals are tailored to individual HCC risk. Doing so can maximize surveillance benefits, minimize surveillance harms, and optimize overall value for all patients.

Evaluation of NanoString Technology for Detection and Genotyping of Human Papillomavirus (HPV)

ObjectiveTo date, CDC's HPV vaccine effectiveness studies have relied on one highly quality‐controlled commercial assay that uses consensus PCR of the HPV L1 gene followed by type‐specific hybridization. However, the reporting process is complex and additional testing is needed to resolve ambiguous results. Alternative assays with increased automation, faster turnaround and digital readout are needed.MethodsWe evaluated NanoString technology as a method for digital readout of the L1 gene for 48 HPV types in a single reaction. Unique probe pairs targeting the L1 and globin genes were designed in collaboration with NanoString. Forty residual DNA extracts from epidemiologic specimens and eight controls were tested directly (no amplification step) as well as after L1 consensus PCR. After overnight hybridization, type‐specific hybridization signals from scans were normalized and background assessed per the recommendations of NanoString. A positive result was defined as specimen‐normalized counts greater than the calculated sample specific background (average+2SD).ResultsThe NanoString assay produces a direct unambiguous readout of type‐specific results directly populating a database without manipulation. HPV detection in plasmid controls was successful only at the highest copy number tested (10,000 copies) and comparison of results of prior method and NanoString in residual extracts showed good type‐specific agreement (k=0.621) but lower sensitivity (65%) of NanoString. With PGMY primer L1 amplification, 45 cycles, hybridizing the highly diluted product gave almost‐perfect type‐specific agreement (k=0.862) between NanoString and prior method. Relative to prior results, NanoString had 82% sensitivity and 99% specificity. Initial evaluation of reduced amplification cycles suggest that sensitivity is maintained with only 15 cycles.ConclusionsThis proof‐of‐principle study demonstrates the potential of using the NanoString platform for highly multiplexed, high throughput and digital genotyping of HPV with a low number of PCR cycles. The platform improves the reliability of data management. NanoString technology is a candidate to improve the quality and reduce the cost of surveillance in studies of HPV and other infectious diseases.Support or Funding InformationSource of research support: Centers for Disease Control and PreventionThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.