ABSTRACT
In December 2019, a novel coronavirus broke out in Wuhan City, Hubei Province, and, as the center of the coronavirus disease 2019 (COVID-19) epidemic, the economy and production throughout Hubei Province suffered huge temporary impacts. Based on the input–output and industrial pollution emissions data of 33 industrial industries in Hubei from 2010 to 2019, this article uses the non-parametric frontier analysis method to calculate the potential production losses and compliance costs caused by environmental regulations in Hubei's industrial sector by year and industry. Research has found that the environmental technology efficiency of the industrial sector in Hubei is showing a trend of increasing year-on-year, but the overall efficiency level is still not high, and there is great room for improvement. The calculation results with and without environmental regulatory constraints indicate that, generally, production losses and compliance costs may be encountered in the industrial sector in Hubei, and there are significant differences by industry. The potential production losses and compliance costs in pollution-intensive industries are higher than those in clean production industries. On this basis, we propose relevant policy recommendations to improve the technological efficiency of Hubei's industrial environment, in order to promote the high-quality development of Hubei's industry in the post-epidemic era.
ABSTRACT
This dissertation is composed of three chapters. While the chapters pertain to very different contexts, an overarching theme is the analysis of human behavior in response to policies that are inherently economic.The first chapter is the product of joint work with Justin Holz and Rafael Jimenez Duran. It studies repugnance towards price gouging. Emergencies like natural disasters or pandemics trigger sharp price increases for essential products. Anti-price gouging laws are ubiquitous and people take costly actions to report violators to law-enforcement agencies, which suggests that they value punishing sellers that spike prices in these situations. This chapter uses a field experiment to understand individuals' willingness to report sellers who increase the price of personal protective equipment at the height of the COVID-19 pandemic. We argue that reporting decisions contain information about repugnance to price gouging and find that willingness to pay to report is non-trivial and heterogeneous. We also find evidence that repugnance is partly due to distaste for seller profits, depending on the product. These results suggest that regulation discussions would benefit from incorporating repugnance into welfare and from addressing products separately.The second chapter focuses in the use of temporary driving restrictions as a tool for air quality management in Mexico City. Road congestion is understood to be a major source of urban air pollution and is also associated with other large non-health-related costs. Millions of people live in cities in which the number of cars on the road is controlled by allowing or prohibiting the use of a car on a given day depending on its license plate number. The empirical evidence available suggests little benefit from these programs;the policy increases the marginal cost of using the road for some users while decreasing it for others and incentivizes the acquisition of extra vehicles. This chapter studies the effect of temporary increases in the stringency of the restrictions as an add-on policy intended to alleviate extreme pollution events. The increased restrictions are triggered by Ozone levels surpassing a pre-specified threshold. This, coupled with the fact that said threshold was modified several times between 2005 and 2018, allows us to identify the effect of the policy. We document a sizable increase in the average speed of cars in the city during restricted days. This suggests the policy does alleviate congestion. We also observe a reduction on Carbon Monoxide and Ozone concentration, but these results are not robust to changes in the specification's functional form. While we cannot explicitly quantify welfare effects, the minor improvements are unlikely to compensate the major disruption in the commuter network without serious investment in public transit alternatives.The third chapter, co-authored with Enrique Seira and Alan Elizondo, investigates the role of information disclosure on financial markets as tool for consumer protection. We implement a randomized control trial in the Mexican credit card market for a large population of indebted cardholders and measure the impact of disclosures of interest rate and time required to pay outstanding debt on default, indebtedness, account closings, and credit scores;these disclosures are required by law in the United States. We also test the effect debiasing warning messages and social comparison information has on the same outcomes. We find that providing salient interest rate disclosures had no effects, while comparisons and debiasing messages had only modest and short-lived effects at best. We conduct extensive external validity exercises in several banks, with different disclosures, and with actual policy mandates. We conclude the null result is robust. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Background: The consumption of antimicrobials and the growing resistance of infectious agents to these drugs are not related only to health issues, but also to economic parameters. Objectives: The study objective was to evaluate the consumption of antimicrobials in General and Covid-19 Intensive Care Units (ICUs) and the impact on institutional costs in the largest institute of a tertiary public hospital. Methods: This is a quantitative and retrospective study, which analyzed consumption, through the Defined Daily Dose (DDD), and the annual direct cost of antimicrobials in Reais (R$) and Dollars (US$), from January to December 2021. Results: The total annual consumption (DDD/1000 patient-day) of antimicrobials in the ICUs was 14,368.85. ß-Lactams had the highest total annual value, with a DDD/1000 patient-day of 7062.98, being meropenem the antimicrobial that reached the highest consumption (3107.20), followed by vancomycin (2322.6). Total consumption was higher in Covid-19 ICUs than in General ICUs, and the annual direct cost of antimicrobials in ICUs was US$560,680.79. Conclusions: The study showed high consumption of broad-spectrum antimicrobials, highlighting the importance of structuring programs to manage the use of antimicrobials, both to reduce antimicrobial consumption and hospital costs, consolidating rational use even in pandemic scenarios.
ABSTRACT
We examine the net benefits of social distancing to slow the spread of COVID-19 in USA. Social distancing saves lives but imposes large costs on society due to reduced economic activity. We use epidemiological and economic forecasting to perform a rapid benefit–cost analysis of controlling the COVID-19 outbreak. Assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of about $5.2 trillion in our benchmark case. We examine the magnitude of the critical parameters that might imply negative net benefits, including the value of statistical life and the discount rate. A key unknown factor is the speed of economic recovery with and without social distancing measures in place. A series of robustness checks also highlight the key role of the value of mortality risk reductions and discounting in the analysis and point to a need for effective economic stimulus when the outbreak has passed.
ABSTRACT
Objective To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic. Methods The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis. Results During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services. Conclusions Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
ABSTRACT
Purpose: This paper aims to investigate potential consumers' willingness to pay for robot-delivered services in travel, tourism and hospitality, and the factors that shape their willingness to pay. Design/methodology/approach: An online survey yielded a sample of 1,573 respondents from 99 countries. Independent samples t-test, Analysis of variance (ANOVA), cluster, factor and regression analyses were used. Findings: Respondents expected to pay less for robot-delivered services than human-delivered services. Two clusters were identified: one cluster willing to pay nearly the same price for robotic services as for human-delivered services, whilst the other expected deep discounts for robotic services. The willingness-to-pay was positively associated with the attitudes towards robots in tourism, robotic service experience expectations, men and household size. It was negatively associated to travel frequency, age and education. Research limitations/implications: The paper's main limitation is its exploratory nature and the use of a hypothetical scenario in measuring respondents' willingness to pay. The data were gathered prior to the COVID-19 pandemic and do not reflect the potential changes in perceptions of robots due to the pandemic. Practical implications: Practitioners need to focus on improving the attitudes towards robots in tourism because they are strongly and positively related to the willingness to pay. The marketing messages need to form positive expectations about robotic services. Originality/value: This is one of the first papers to investigate consumers' willingness to pay for robot-delivered services in travel, tourism and hospitality and factors that shape their willingness to pay. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
The COVID-19 pandemic has led to an unprecedented rise in rates and symptoms of eating disorders among Canadian youth. To date, there is a lack of national surveillance and costing data in Canada to inform policymakers and healthcare leaders on how to best address the surge in new and existing cases. This has resulted in the Canadian healthcare system being unprepared to adequately respond to the increased needs. Therefore, clinicians, researchers, policymakers, decision-makers, and community organizations across Canada are collaborating to compare pre-and post-pandemic costing data from national and province-level healthcare systems in an effort to address this gap. Results from this economic cost analysis will be an important first step in informing and guiding policy on possible adaptations to services to better fulfill the needs of youth with eating disorders in Canada. We highlight how gaps in surveillance and costing data can impact the field of eating disorders in an international context.
ABSTRACT
INTRODUCTION: Clinical research can be expensive and time consuming due to high associated costs and/or duration of the study. We hypothesized that urine sample collection using online recruitment and engagement of research participants via social medial has the potential to reach a large population in a small timeframe, at a reasonable cost. METHODS: We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants for urine sample collection. During this time, cost data were collected based on study associated costs from invoices and budget spreadsheets. The data were subsequently analyzed using descriptive statistics. RESULTS: Each sample collection kit contained 3 urine cups, 1 for the disease sample and 2 for control samples. Out of the 3,576 (1,192 disease + 2,384 control) total sample cups mailed, 1,254 (695 control) samples were returned. Comparatively, the 2 clinical sites collected 305 samples. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $81.45 compared to $398.14 for clinic sample. CONCLUSIONS: We conducted a nationwide, contactless, urine sample collection through online recruitment in the midst of the COVID-19 pandemic. Results were compared with the samples collected in the clinical setting. Online recruitment can be utilized to collect urine samples rapidly, efficiently, and at a cost per sample that was 20% of an in-person clinic, and without risk of COVID-19 exposure.
ABSTRACT
With the explosion of COVID-19 cases and the government's needs to control virus spreading, the development of effective and robust systems for managing vaccination certificates to restrict citizens' activities has been in the centre of many governments. This paper proposes a system that allows for the update of the status of certificates and bases its function on a specific form of logs stored on Blockchains and a set of rules for the interpretation of these logs. Also an outline of a proof of concept implementation of the system in Ethereum together with a cost and security analysis are provided in the paper. The proposed architecture provides several benefits with the most prominent one being the suspension of certificates in case an already vaccinated individual is found positive. In existing certificate management systems a vaccinated individual that is tested positive still holds a valid vaccination certificate during the self-isolation period. This vulnerability allows infected individuals to commute freely and thus facilitates the spread of the pandemic. The proposed solution is not limited to COVID-19 related certificates, but rather it could be deployed in any kind of digital certificate. © 2022 ACM.
ABSTRACT
This study presents internet of things (IOT) and artificial intelligence technologies that are critical in reducing the harmful effects of this illness and assisting its recovery. It explores COVID-19's economic impacts before learning about new technologies and potential solutions. The research objective was to propose a solution for self-diagnosis, self-monitoring, and self-management of COVID-19 with personal mobiles and personal data using cloud solutions and mobile applications with the help of an intelligent IoT system, artificial intelligence, machine learning, and 5G technologies. The proposed solution based on self-diagnosis without any security risk for users' data with low cost of cloud-based data analytics by using handsets only is an innovative approach. Since the COVID-19 outbreak, the global social, economic, religious, and cultural frameworks and schedules have been affected adversely. The fear and panic associated with the new disease, which the world barely knew anything about, amplified the situation. Scientists and epidemiologists have traced the first outbreak of COVID-19 at Wuhan, China. A close examination of the genetic makeup of the virus showed that the virus is zoonotic, meaning that the virus changed hosts from animals to humans. The uncertainty associated with the above features and characteristics of the virus, as well as the high mortality rates witnessed in many parts of the globe, significantly contributed to the widespread global panic that brought the world to a standstill. Different authorities and agencies associated with securing the public have implemented different means and methods to try and mitigate the transmission of the infection as scientists and medical practitioners work on remedies to curb the spread of COVID-19. Owing to different demographics, different parts of the globe have attempted to effectively implement locally available resources to efficiently fight and mitigate the adverse effects of the COVID-19 pandemic. The general framework provided by the World Health Organization (WHO) has been implemented or enhanced in different parts of the globe by locally available resources and expertise to effectively mitigate the impact of COVID-19. There is currently no effective vaccine for COVID-19, but new technology can be available within weeks to reduce the spread of the disease;current approaches such as contact tracing and testing are not secure, and the cost of testing is high for end users. The proposed solution based on self-diagnosis without any security risk for users' data with low cost of cloud-based data analytics functions by using an intelligent internet of things (IOT) system for collecting sensors data and processing them with artificial intelligence to improve efficiency and reduce the spread of COVID-19.
ABSTRACT
Background During the promotion of category-based management for community healthcare institutions （class 1 institutions obtain the financial security，and class 2 institutions implement a performance management system），how to appropriately determine the security level and scientifically evaluate the performance is a difficulty to tackle for health administrative departments. Objective To assess the operational efficiency of community healthcare institutions with the data envelopment analysis（DEA） using the information of costs of these institutions calculated using the equivalent method，then attempt to develop an input and management model of integrating cost accounting and performance management for these institutions，providing a theoretical basis for accurate and scientific input of various resources into the community through cost measurement with equivalent method，and a data basis for performance assessment in communities with different characteristics through efficiency evaluation. Methods The real data（financial status and staffing） of 14 community healthcare institutions during 2019 to 2020 were collected from their financial reports，hospital information system，maternal and child healthcare information system，chronic disease management information system，as well as focus group interviews. The equivalent method was used to calculate the total costs of medical services and public health services. The super-efficiency DEA was used to evaluate and analyze the operational efficiency of the 14 sample institutions. Results （1）The average cost of one equivalent service（a general medical outpatient service lasting for 15 minutes was defined as one standard service equivalent unit） was 67.64 yuan in 2019 and 69.80 yuan in 2020 for the 14 institutions. The average cost of one equivalent essential medical service was higher than that of one equivalent public health service in both 2019（167.14 yuan vs 18.86 yuan） and 2020（215.43 yuan vs 19.78 yuan）. The institutions demonstrated significant differences in the average cost of one equivalent essential medical service and the average cost of one equivalent public health service. （2）Each institution had its own peculiar characteristics. For example，S1 institution mainly provided essential medical services，and had higher total equivalent essential medical services and efficiency than other institutions，while S9 institution focused on providing public health services，and had the highest efficiency in delivering public health services. （3）In 2020，the 14 institutions provided 134 800 equivalent COVID-19-related services，with a cost of 1.037 8 million yuan. （4）In 2019 and 2020，only two institutions were relatively overall efficient，and ≥ 50.0% institutions were pure technically efficient. The institutions with overall operational inefficiency were mainly caused by scale inefficiency primarily due to increasing returns to scale. Conclusion The equivalent method provides a relatively unified "scale" to standardize the service efficiency of different types of community healthcare institutions，provides support for health administrative departments implementing category-based compensation for the institutions，benefiting the featured and high-level development of community healthcare institutions. Either institutions delivering essential medical services or those delivering public health services，mainly present increasing returns to scale，suggesting that the efficiency of these institutions can be improved by increasing the human/financial/material input into the institutions and providing precise compensation for them. © 2023 Chinese General Practice. All rights reserved.
ABSTRACT
The recent outbreak of novel coronavirus has highlighted the need for a benefit-cost framework to guide unconventional public health interventions aimed at reducing close contact between infected and susceptible individuals. In this paper, we propose an optimal control problem for an infectious disease model, wherein the social planner can control the transmission rate by implementing or lifting lockdown measures. The objective is to minimize total costs, which comprise infection costs, as well as fixed and variable costs associated with lockdown measures. We establish conditions concerning model primitives that guarantee the existence of a straightforward optimal policy. The policy specifies two switching points (Formula presented.), whereby the social planner institutes a lockdown when the percentage of infected individuals exceeds (Formula presented.), and reopens the economy when the percentage of infected individuals drops below (Formula presented.). We subsequently extend the model to cases where the social planner may implement multiple lockdown levels. Finally, numerical studies are conducted to gain additional insights into the value of these controls. © 2023 Wiley Periodicals LLC.
ABSTRACT
PurposeDrawing on the social exchange theory, stakeholder theory and extended theory of reasoned action, this study aims to investigate how consumers view the economic and sociocultural impacts (benefits/costs) of peer-to-peer (P2P) accommodations on the local community's resilience and how consumers form behavioral intentions toward P2P accommodation as a part of sustainable tourism behavior.Design/methodology/approachWith data from a survey of 300 consumers who have previously used P2P accommodation, the authors performed partial least squares-structural equation modeling to test the proposed model and hypotheses.FindingsThe current study reveals the significant impact of the sociocultural benefits of P2P accommodations on consumers' perceived community resilience, while economic benefits have a non-significant impact on perceived community resilience. Moreover, neither the sociocultural nor economic costs of P2P accommodation significantly reduce consumers' perceived community resilience. Furthermore, the authors found significant positive relationships among perceived community resilience, attitude, subjective norm, personal norm and behavioral intentions.Practical implicationsP2P accommodation platforms can leverage these research findings and contribute to the community resilience and help community residents by establishing strategic collaboration with various stakeholders (e.g. governments, destination marketing organizations and non-profit organizations) for the community's sustainable development.Originality/valueThis study systematically investigates the role of P2P accommodation in achieving community resilience by categorizing the impacts of P2P accommodation into economic and sociocultural benefits/costs.
ABSTRACT
Este documento trata sobre cómo aprender de la experiencia pasada y cómo avanzar hacia las nuevas formas de capitalismo que deben estar en el centro de un sistema impulsado por la misión, en el que los grandes problemas de nuestro tiempo, como la brecha digital, los sistemas sanitarios y el cambio climático sean centrales, y cómo trabajar juntos para abordarlos. Este documento trata sobre cómo diseñar un sistema de producción que sea colectivo, pero sobre todo que distribuya adecuadamente las recompensas, en lugar de la forma disfuncional en que lo hacemos actualmente, que consiste en socializar los riesgos y los costes y privatizar después los beneficios. He tenido el honor de trabajar con responsables políticos de todo el mundo para llevar la noción de reto, propósito e impulso hacia la misión al corazón del diseño de las políticas públicas. Este documento trata también de los cambios sistémicos, de lo que realmente significan, de cómo entendemos la economía, de cómo producir de otra manera.Alternate :This paper is about how to learn from past experience and how to move towards the new forms of capitalism that must be at the heart of a mission-driven system, in which the big issues of our time such as the digital divide, health systems and climate change are central, and how to work together to address them. This paper is about how to design a production system that is collective, but more importantly one that properly distributes the rewards, rather than the dysfunctional way we currently do it, which is to socialise the risks and costs and then privatise the benefits. I have had the honour of working with policy makers around the world to bring the notion of challenge, purpose and mission-drive to the heart of public policy design. This paper is also about systemic change, about what it really means, about how we understand the economy, about how to produce differently.
ABSTRACT
Objective: The aim of the study is to estimate the direct treatment cost of COVID-19 cases in ICU and Ward, and the average length of stay during the pandemic period. Material and methods: The cost study was carried out from the provider's perspective in a tertiary hospital in Ankara. Only direct costs during hospitalization were analyzed excluding medication costs. The Average Length of Stay (LOS) was determined. The cost was estimated for COVID-19 patients that were admitted to the ward and intensive care unit (ICU) by gender and age group. Patient medical records were reviewed retrospectively in a period of 1 month (April 1, 2020 - April 30, 2020) for clinical data and patient hospital bills were used for costing data. Result: A total of 525 COVID-19 patients were admitted to the hospital. Slightly more than half of the COVID-19 patients were male (52.1% overall) and the mean age was 47.5±18.6 years for males and 51.0±19.4 for females. Overall, 4.4% of COVID-19 cases were among children and adolescents (≥18 years), 72.8% were among adults (19–64 years), and 22.9% were among elderly adults (≥ 65 years). The direct cost estimated for COVID-19 ranged from 3,781.77 Turkish liras (TL) to 32,494.98 TL. The average LOS for ICU TL patients and ward patients were 4, 5, and 6 days, respectively. Conclusion: The cost of treating COVID-19 in ICU is high compared to the treatment costs in the ward. The average length of stay for COVID-19 cases in ICU was longer among elderly patients.
ABSTRACT
Since the 2019 Canada Food Guide was released, there have been concerns raised over the cost of food, with an emphasis on the affordability of nutritious food. In this study, we evaluate the affordability of the 2019 Canada Food Guide in relation to the previous edition from 2007. As a result of the pandemic and other significant world events, many are feeling financial stress as prices in many areas of life rise, including housing, gas, and food. Our results show that it is more cost-effective, on average, for children and teens to follow the 2019 Canada Food Guide, but more expensive for adults, when compared to the 2007 edition.
ABSTRACT
The 2018 United Nations High-Level Meeting on Tuberculosis (UNHLM) set targets for case detection and TB preventive treatment (TPT) by 2022. However, by the start of 2022, about 13.7 million TB patients still needed to be detected and treated, and 21.8 million household contacts needed to be given TPT globally. To inform future target setting, we examined how the 2018 UNHLM targets could have been achieved using WHO-recommended interventions for TB detection and TPT in 33 high-TB burden countries in the final year of the period covered by the UNHLM targets. We used OneHealth-TIME model outputs combined with the unit cost of interventions to derive the total costs of health services. Our model estimated that, in order to achieve UNHLM targets, >45 million people attending health facilities with symptoms would have needed to be evaluated for TB. An additional 23.1 million people with HIV, 19.4 million household TB contacts, and 303 million individuals from high-risk groups would have required systematic screening for TB. The estimated total costs amounted to ~USD 6.7 billion, of which ~15% was required for passive case finding, ~10% for screening people with HIV, ~4% for screening household contacts, ~65% for screening other risk groups, and ~6% for providing TPT to household contacts. Significant mobilization of additional domestic and international investments in TB healthcare services will be needed to reach such targets in the future.
ABSTRACT
Despite perioperative advantages, robot-assisted surgery is associated with high costs. However, the lower morbidity of robotic surgery could lead to a lower nursing workload and cost savings. In this comparative cost analysis of open retroperitoneal versus robot-assisted transperitoneal partial nephrectomies (PN), these possible cost savings, including other cost factors, were quantified. Therefore, patient, tumor characteristics, and surgical results of all PN within two years at a tertiary referral center were retrospectively analyzed. The nursing effort was quantified by the local nursing staff regulation and INPULS® intensive care and performance-recording system. Out of 259 procedures, 76.4% were performed robotically. After propensity score matching, the median total nursing time (2407.8 vs. 1126.8 min, p < 0.001) and daily nursing effort (245.7 vs. 222.6 min, p = 0.025) were significantly lower after robotic surgery. This resulted in mean savings of EUR 186.48 in nursing costs per robotic case, in addition to savings of EUR 61.76 due to less frequent administrations of erythrocyte concentrates. These savings did not amortize the higher material costs for the robotic system, causing additional expenses of EUR 1311.98 per case. To conclude, the nursing effort after a robotic partial nephrectomy was significantly lower compared to open surgery; however, this previously unnoticed savings mechanism alone could not amortize the overall increased costs.
ABSTRACT
BACKGROUND: Our study aimed to establish 'real-world' performance and cost-effectiveness of ovarian cancer (OC) surveillance in women with pathogenic germline BRCA1/2 variants who defer risk-reducing bilateral salpingo-oophorectomy (RRSO). METHODS: Our study recruited 875 female BRCA1/2-heterozygotes at 13 UK centres and via an online media campaign, with 767 undergoing at least one 4-monthly surveillance test with the Risk of Ovarian Cancer Algorithm (ROCA) test. Surveillance performance was calculated with modelling of occult cancers detected at RRSO. The incremental cost-effectiveness ratio (ICER) was calculated using Markov population cohort simulation. RESULTS: Our study identified 8 OCs during 1277 women screen years: 2 occult OCs at RRSO (both stage 1a), and 6 screen-detected; 3 of 6 (50%) were ≤stage 3a and 5 of 6 (83%) were completely surgically cytoreduced. Modelled sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for OC were 87.5% (95% CI, 47.3 to 99.7), 99.9% (99.9-100), 75% (34.9-96.8) and 99.9% (99.9-100), respectively. The predicted number of quality-adjusted life years (QALY) gained by surveillance was 0.179 with an ICER cost-saving of -£102,496/QALY. CONCLUSION: OC surveillance for women deferring RRSO in a 'real-world' setting is feasible and demonstrates similar performance to research trials; it down-stages OC, leading to a high complete cytoreduction rate and is cost-saving in the UK National Health Service (NHS) setting. While RRSO remains recommended management, ROCA-based surveillance may be considered for female BRCA-heterozygotes who are deferring such surgery.