Cost Of Surveillance Research Articles

Cost implications of multi-parametric magnetic resonance imaging in prostate cancer active surveillance.

65 Background: Multi-parametric resonance imaging (mpMRI) has emerged to improve disease risk-stratification and decrease number of repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on cost of AS has not been established. We thus characterize the impact mpMRI on cost of AS in the Medicare population. Methods: Using SEER-Medicare files we identified men ≥66 years old with localized grade group I-II prostate cancer diagnosed 2008-2013. With an established algorithm, we classified men into active surveillance with and without mpMRI. We then determined cost of surveillance in each group using inflation-adjusted Medicare payments for surveillance-related procedures and their sequalae (i.e. PSA tests, prostate biopsies, post-biopsy complications and mpMRIs). Multivariable median regression compared cost and procedural-intensity for men who received mpMRI and those who did not. Results: We identified 9,081 men on AS with median follow up 45 months (IQR 29-64 months). 7,856 (87%) men did not receive mpMRI and 1,225 (13%) did. On multivariable median regression, receipt of mpMRI was associated with an additional $449 (95%CI $391-$507) in Medicare payments per year. Younger age, treatment in the west or northeast, greater population density and treatment later in the study period were associated with increased cost of AS. Conclusions: Among Medicare beneficiaries on AS, mpMRI is associated with additional annual cost to Medicare. MpMRI may be a marker of more stringent AS, which is likely more costly than watchful waiting. Future studies are needed to determine optimal use of mpMRI during AS to maximize value.

705 - Evaluating the cost of surveillance for non-muscle invasive bladder cancer: An economic analysis based on risk categories

705 - Evaluating the cost of surveillance for non-muscle invasive bladder cancer: An economic analysis based on risk categories

Web-based patient surveillance cost effective in lung cancer

Web-based patient surveillance cost effective in lung cancer

Kesiapan Industri Rumah Tangga Mebel terhadap Penerapan Sistem Verifikasi Legalitas Kayu di Yogyakarta

Illegal logging and illegal timber trade have been ones of major causes of deforestation in many countries, including Indonesia. Indonesian Timber Legality Assurance System (Sistem Verifikasi Legalitas Kayu/SVLK) is an instrument to improve governance of timber sector. The system ensures the legality of timber harvested, transported, processed, and marketed by Indonesian forestry enterprises. SVLK is developed through engagement of multi-stakeholder (scholars, business association, relevant ministries, and NGOs). Implementation of SVLK is mandatory. Since implemented, SVLK has increased export of forest products. However, the export is dominated by large scale enterprises. On other hand, many of small and medium scale industries are yet registered. Micro and small scale industries have basic difficulties to meet the applicable standards of SVLK. According to background and issues, the study aims to analyze distribution network, small business profit, cost of SVLK implementation, and the application of svlk feasibility financial simulation on small scale industries furniture. Primary data collection was carried out with purposive sampling method through deep interview and questionnaires. The result showed there were 3 alternative distribution channels of community wood marketing in Yogyakarta. Each distribution channel has different characteristics. Cost percentage of SVLK implementation is 4.00%. The actual challenge is in the equally distributed information and incompatibility between the requirements of SVLK and the life of small scale industries. SVLK requires Rp 7.787.500,- in early periode and Rp 6.230.000,- to be paid every 2 years. The total cost is Rp 32.707.500,- for 10 years. There are only 7% of small scale industries knowing about SVLK. Small scale industries which don’t know clearly is 50 %, while other small scale industries claim to be uninformed. Based on the study, NPV Rp 10.011.212,-, BCR 1,13 dan investment return rate 18%. Feasibility financial simulation showed SVLK implementation is possible, although has little positive sales development. Small scale furniture industries with 144 m3 raw material per year usage have to target 12% sales development in first year. In second year of implementation, small scale furniture industries cashflow has negative point. It caused by surveillance cost. Small scale furniture industries interest to SVLK implementation was in minimum point. Small scale furniture industries interest to SVLK implementation can be increased by certification financing programs and the export market assurance.

Characterising the costs of the Global Polio Laboratory Network: a survey-based analysis

ObjectiveTo characterise the costs, including for environmental surveillance (ES), of the Global Polio Laboratory Network (GPLN) that provides laboratory support to the Global Polio Eradication Initiative (GPEI).Design and participantsWe conducted...

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

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

The Social Costs of Digital vs. In-Person Surveillance

The Social Costs of Digital vs. In-Person Surveillance

Active surveillance cost effective for low-risk prostate cancer

Active surveillance cost effective for low-risk prostate cancer

Q-TWiST and Cost-Effectiveness Analysis of Endovascular versus Open Repair for Ruptured Abdominal Aortic Aneurysms in a High Deliberate Practice Volume Center

The objective of the study was to compare the cost-effectiveness of endovascular aortic repair (rEVAR) versus open surgical repair (rOSR) for ruptured abdominal aortic aneurysm (rAAA), where rEVAR is regularly performed outside of instructions for use (IFUs) (shorter and more angulated necks). Primary end point is incremental cost-effectiveness ratio (ICER) of rEVAR versus rOSR and aneurysm-related mortality. Secondary end points are cost per quality-adjusted life years (QALYs), perioperative morbidity and mortality, reintervention, and all-cause mortality. All rAAA repairs performed between 2002 and 2016 in a single center were scrutinized. Between 2002 and 2007, most rAAAs were repaired using rOSR. From 2007 to 2016, we implemented a rEVAR with an anatomically possible protocol. During this time, severe angulation was rarely seen as a contraindication to rEVAR, and rEVAR was performed on aneurysms with an infrarenal aortic neck cranial to the aneurysm with a diameter of 20-33mm and a length of at least 5mm. Demographics and outcomes were reported according to the Society for Vascular Surgery guidelines. QALY was measured based on quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) assessment. Eight hundred aneurysm surgeries were performed; of these, 135 were emergency surgeries of which 88 were for rAAA; (42 rEVARs and 46 rOSRs). Primary technical success (rEVAR 89.1% vs. rOSR 87.8%; P=0.1), perioperative morbidity (rEVAR 56.5% vs. rOSR 64.3%; P=0.457), and mortality (rEVAR 26.1% vs. rOSR 28.6%; P=0.794) were nonsignificantly favorable in rEVAR patients. Freedom from reintervention was significantly lower in rEVAR patients at 3years (rEVAR 74% vs. rOSR 90%; P=0.038). Three-year aneurysm-related survival (rEVAR 65% vs. rOSR 62%; P=0.848) and all-cause survival (rEVAR 56% vs. rOSR 51%; P=0.577) were higher in rEVAR patients. At 3years, rEVAR patients had a higher QALY of 1.671 versus OSR of 1.549 (P=0.502). Operating room (P=0.001) and total accommodation costs (P=0.139) were lower in rEVAR patients, while equipment (P<0.001), surveillance, and reintervention (P<0.001) costs were higher. Median cost of rEVAR at 3years was €23,352 vs. €20,494 for OSR (P<0.084) (power>80%). Median cost per QALY of rEVAR at 3years was €13,974 vs. €13,230 for rOSR (P=0.296). ICER for rEVAR versus rOSR was €23,426 (95% confidence interval [CI] < €0 to > €30,000). At 3 years, the area under the curve and 95% CI for Q-TWiST was higher in rEVAR compared with OSR (rEVAR 500.819 vs. rOSR 437.838). There is no significant difference in cost or QALYs between rEVAR and rOSR even when rEVAR is performed on complex cases outside of IFU (shorter and more angulated necks). There is a significantly higher freedom from secondary intervention in rOSR patients compared with rEVAR patients at 3years.

Evaluating the cost of surveillance for non-muscle-invasive bladder cancer: an analysis based on risk categories.

Non-muscle-invasive bladder cancer (NMIBC) is a biologically heterogeneous disease and is one of the most expensive malignancies to treat on a per patient basis. In part, this high cost is attributed to the need for long-term surveillance. We sought to perform an economic analysis of surveillance strategies to elucidate cumulative costs for the management of NMIBC. A Markov model was constructed to determine the average 5-year costs for the surveillance of patients with NMIBC. Patients were stratified into low, intermediate, and high-risk groups based on the EORTC risk calculator to determine recurrence and progression rates according to each category. The index patient was a compliant 65-year-old male. A total of four health states were utilized in the Markov model: no evidence of disease, recurrence, progression and cystectomy, and death. Cumulative costs of care over a 5-year period were $52,125 for low-risk, $146,250 for intermediate-risk, and $366,143 for high-risk NMIBC. The primary driver of cost was progression to muscle-invasive disease requiring definitive therapy, contributing to 81% and 92% of overall cost for intermediate- and high-risk disease. Although low-risk tumors have a high likelihood of 5-year recurrence, the overall cost contribution of recurrence was 8%, whereas disease progression accounted for 71%. Although protracted surveillance cystoscopy contributes to the expenditures associated with NMIBC, progression increases the overall cost of care across all three patient risk groups and most notably for intermediate- and high-risk disease patients.

Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance.

To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes. Women with pregestational diabetes have a 3- to 5-fold increased odds of stillbirth compared to women without diabetes. The stillbirth risk in women with gestational diabetes (GDM) is more controversial; while recent data suggest the odds for stillbirth are approximately 50% higher in women with GDM at term (37weeks and beyond) than in those without GDM, it is unclear if this risk is seen in women with optimal glycemic control. Current professional society guidelines are broad with respect to fetal testing strategies and delivery timing in women with diabetes. The data supporting strategies to reduce the risk of stillbirth in women with diabetes are limited. Antepartum fetal surveillance should be performed to reduce stillbirth rates; however, the optimal test, frequency of testing, and delivery timing are not yet clear. Future studies of obstetric management for women with diabetes should consider not just individual but also system level costs and benefits associated with antenatal surveillance.

The Futility of Surveillance for Old and Small Aneurysms

Inspired by the Canadian Choosing Wisely campaign, we investigated the yield and cost of ultrasound surveillance for small abdominal aortic aneurysms (AAAs) in octogenarians, compared with a younger population, for detecting AAA growth that reaches a sex-specific threshold size for repair. A retrospective cohort review was performed of all patients undergoing AAA surveillance in Ottawa between 2007 and 2017. Patients were dichotomized by enrollment age (<80 years vs ≥80 years) with crossover to prevent lead time bias and stratified by enrollment AAA size. These cohorts were cross-referenced with the Ottawa AAA repair database, leveraging the common Local Health Integration Network to ensure data capture. Survival analysis with Cox proportional hazards models adjusted for significant covariates, and cost-effectiveness analysis was performed referencing Ontario Health Insurance Plan codes. A total of 1378 patients underwent serial ultrasound surveillance. In 355 (25.8%), the AAA size threshold for repair was reached, and 313 (22.1%) underwent AAA repair. Octogenarians were half as likely as their younger counterparts to experience significant AAA growth (hazard ratio, 0.51; 95% confidence interval [CI], 0.37-0.83; Fig 1, A). Similarly, octogenarians were half as likely to experience an aortic event, a composite outcome including threshold-sized AAA, elective aortic repair, or aortic rupture (hazard ratio, 0.54; 95% CI, 0.43-0.68; Fig 1, B). When a threshold-sized AAA was identified, octogenarians were half as likely to undergo elective AAA repair (relative risk, 0.52; 95% CI, 0.45-0.59; Fig 2, A). Both ruptured AAA repair (0.94%) and procedure-related 30-day mortality (0.58%) were rare, and age differences were insignificant (Fig 2, B). AAA surveillance for octogenarians was substantially less cost-effective, incurring $12,080 in surveillance fees to identify one octogenarian with an AAA size of 3 to 3.9 cm who later underwent elective AAA repair (Fig 2, C and D). Octogenarians with small aneurysms are half as likely to experience significant aortic growth. Furthermore, in the unlikely event of AAA growth, octogenarians are half as likely to undergo repair, without a significantly increased risk of requiring repair for AAA rupture. The differences in natural history between the young and elderly patients suggest a difference in aneurysm pathophysiology. In the context of patient-specific factors, surveillance of AAAs <4 cm in octogenarians is costly and unlikely to be beneficial.Fig 2Incidence of abdominal aortic aneurysm (AAA) repair and resulting cost-effectiveness analysis. Groups are stratified by enrollment age and size of AAA at time of enrollment. A, When a threshold-sized AAA was reached, octogenarians were less likely to undergo elective AAA repair than their younger counterparts (overall relative risk, 0.52; 95% confidence interval, 0.45-0.59). B, Repair of ruptured AAA for patients in the surveillance program was rare, and differences were not statistically significant. C, Cost-effectiveness analysis incorporates a base cost of $89.20 for each surveillance ultrasound (Ontario Health Insurance Plan: code H 2, $57.00 technical cost; code P J202, $32.20 professional cost). D, Whereas the cost of surveillance to identify threshold-sized AAA was comparable between age cohorts, there was substantially more discrepancy in the cost of surveillance to prompt elective AAA repair.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Invited Commentary

Invited Commentary

Pengaruh Diversitas Dewan dan kinerja keuangan terhadap voluntary corporate disclosure

&lt;p&gt;More disclosure can reduce agency costs incurred by the company. The more management (agent) reveal information about the company can reduce the conflict to shareholders (principal). Therfore, a voluntary disclosure more to minimize the occurence of information asymmetry. The more management companies disclose information about the incentives obtained become more, because basically shareholders (principal) would be willing to pay the cost of monitoring surveillance to prevent the hazard of the agent.&lt;/p&gt;&lt;p&gt;The aim of this study is to analyze and discribe how diversity influences gender and educational background of the board as well as the financial performance of the corporate voluntary disclosure. Definition councils in this study combines the board of commissioners and board of directors, because indonesia is adopting a two-tier system. The companies sampled is a company registered in the Indonesia Stock Exchange (IDX).&lt;/p&gt;Adjusted R-squere value (0.55) shows that voluntary corporate disclosure nearly 55% depending on the independent variable is gender diversity of the board, board diversity educational backgrounds, profitability, size, liquidity and liverage of the company. Significance test showed that gender diversity and leverage are important determinants of corporate voluntary disclosure in Indonesia. On the other hand, the research also found that the variable gender diversity, provitability, size and liquidity is not strong explanatory variables to determine the extent of voluntary disclosure of company in Indonesia.

Surveillance as a Topic of Study in the Work of E. Lockhart and Cory Doctorow

Surveillance technologies are proliferating at an astonishing rate powered by practices that normalize surveillance. Children and young adults are especially prone to being surveilled since few people challenge the idea that protecting young people is a valuable goal. Yet, both E. Lockhart in The Disreputable History of Frankie Landau Banks (2008) and Cory Doctorow in Little Brother (2008a) demonstrate that, for young adults on the cusp of independence, recognizing the costs of surveillance and developing the skills to manage surveillance is a crucial skill. Lockhart showcases Frankie’s progress as she shifts from using surveillance to gain personal power to understanding she can enact real change by challenging the gendered assumptions of the panopticon and adopting transparency about her goals. Doctorow’s protagonist advocates for young people to become better practitioners of technology in order to assert agency over the ways they are surveilled. Both authors use their protagonists to demonstrate the importance of resisting the promised comforts of protective and patriarchal surveillance as a necessary step in establishing a balance between the independent self and the society in which one participates.

Economic Analysis of a Noninvasive Molecular Pathologic Assay for Pigmented Skin Lesions

A recently described noninvasive gene expression test (the pigmented lesion assay [PLA]) with adhesive patch-based sampling has the potential to rule out melanoma and the need for surgical biopsy of pigmented lesions suggestive of melanoma with a negative predictive value of 99% compared with 83% for the histopathologic standard of care. The cost implications of using this molecular test vs visual assessment followed by biopsy and histopathologic assessment (VAH) have not been evaluated. To determine potential cost savings of PLA use vs the VAH pathway. This health economic analysis performed from a US payer perspective was based on consensus treatment guidelines and fee schedules from the Centers for Medicare & Medicaid Services. Data for model input were derived from routine use of the test in US dermatology practices and literature. Participants included patients with primary cutaneous pigmented lesions suggestive of melanoma. Data were analyzed from February 8 to December 1, 2017. The primary analysis consisted of the relative reduction in costs of diagnostic surgical procedures for PLA vs VAH management. Additional analyses included stage-related treatment costs associated with delays in diagnosis. In the cost analysis for this economic model, the relative reduction in surgical procedure costs (biopsy and subsequent excision), assuming $0 for the PLA to facilitate multiple comparison scenarios, was -$395 compared with VAH. The relative reduction in stage-related treatment costs associated with the PLA was -$433 compared with VAH, primarily associated with avoidance of delays due to false-negative diagnoses. Surveillance costs were reduced by -$119 with the PLA. The total cost of fully adjudicating a lesion suggestive of melanoma by VAH was $947. At a mean selling price reference point for PLA of $500, cost savings of $447 (47%) per lesion tested could be realized. The results of this analysis suggest that the PLA reduces cost and may improve the care of patients with primary pigmented skin lesions suggestive of melanoma.

Mathematical analysis to prioritise strategies for malaria elimination

Malaria and some other tropical diseases are currently targeted for elimination and eventually eradication. Since resources are limited, prioritisation of countries or areas for elimination is often necessary. However, this prioritisation is frequently conducted in an ad hoc manner. Lower transmission areas are usually targeted for elimination first, but for some areas this necessitates long and potentially expensive surveillance programs while transmission is eliminated from neighbouring higher transmission areas. We use a mathematical model to compare the implications of prioritisation choices in reducing overall burden and costs. We show that when the duration of the elimination program is independent of the transmission potential, burden is always reduced most by targeting high transmission areas first, but to reduce costs the optimal ordering depends on the actual transmission levels. In general, when overall transmission potential is low and the surveillance cost per secondary case compared to the cost per imported case is low, targeting the higher transmission area for elimination first is favoured.

National surveillance and control costs for highly pathogenic avian influenza H5N1 in poultry: A benefit-cost assessment for a developing economy, Nigeria

We conducted benefit-cost analysis of outbreak and surveillance costs for HPAI H5N1in poultry in Nigeria. Poultry's death directly cost US$ 939,734.0 due to outbreaks. The integrated disease surveillance and response originally created for comprehensive surveillance and laboratory investigation of human diseases was adapted for HPAI H5N1 in poultry. Input data were obtained from the field, government documents and repositories and peer-reviewed publications. Actual/forecasted bird numbers lost were integrated into a financial model and estimates of losses were calculated. Costs of surveillance as alternative intervention were determined based on previous outbreak control costs and outputs were generated in SurvCost® with sensitivity analyses for different scenarios.Uncontrolled outbreaks will lead to loss of over US$ 2.2 billion annually in Nigeria with 47.8% of the losses coming from eggs. The annual cost of all animal related health activities was <US$ 99.0 million, only one-third of this amount was linked with H5N1 surveillance and response activities. Recurrent cost was 96.2% of the total surveillance and response costs, and 31.0% of the HPAI surveillance cost was spent on personnel with 3.8% as capital cost. Cost-wisely, routine monitoring and surveillance for HPAI are 68 times more cost effective than to do nothing. Assuming that successful control and eradication of HPAI H5N1 is partially attributable to H5N1 surveillance and response, a quarter or half of the success will result in 17 or 34 times more benefits. Although animal surveillance and response activities for avian influenza appeared expensive, their implementation are economically cost beneficial for developing countries.

Comparison of Alternative Meat Inspection Regimes for Pigs From Non-Controlled Housing - Considering the Cost of Error.

Denmark has not had cases of bovine tuberculosis (bovTB) for more than 30 years but is obliged by trade agreements to undertake traditional meat inspection (TMI) of finisher pigs from non-controlled housing to detect bovTB. TMI is associated with higher probability of detecting bovTB but is also more costly than visual-only inspection (VOI). To identify whether VOI should replace TMI of finisher pigs from non-controlled housing, the cost of error – defined here as probability of overlooking infection and associated economic costs - should be assessed and compared with surveillance costs. First, a scenario tree model was set up to assess the ability of detecting bovTB in an infected herd (HSe) calculated for three within-herd prevalences, WHP (1, 5 and 10%), for four different surveillance scenarios (TMI and VOI with or without serological test, respectively). HSe was calculated for six consecutive 4-week surveillance periods until predicted bovTB detection (considered high-risk periods HRP). 1-HSe was probability of missing all positives by each HRP. Next, probability of spread of infection, Pspread, and number of infected animals moved were calculated for each HRP. Costs caused by overlooking bovTB were calculated taking into account Pspread, 1-HSe, eradication costs, and trade impact. Finally, the average annual costs were calculated by adding surveillance costs and assuming one incursion of bovTB in either 1, 10 or 30 years. Input parameters were based on slaughterhouse statistics, literature and expert opinion. Herd sensitivity increased by high-risk period and within-herd prevalence. Assuming WHP=5%, HSe reached median 90% by 2nd HRP for TMI, whereas for VOI this would happen after 6th HRP. Serology had limited impact on HSe. The higher the probability of infection, the higher the probability of detection and spread. TMI resulted in lowest average annual costs, if one incursion of bovTB was expected every year. However, when assuming one introduction in 10 or 30 years, VOI resulted in lowest average costs. It may be more cost-effective to focus on imported high-risk animals coming into contact with Danish livestock, instead of using TMI as surveillance on all pigs from non-controlled housing.

Approaching Evaluations of Surveillance System Pilots through an Ownership Perspective

Approaching Evaluations of Surveillance System Pilots through an Ownership Perspective