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Grant Details

Grant Number: 5U01CA183081-02 Interpret this number
Primary Investigator: Mandelblatt, Jeanne
Organization: Georgetown University
Project Title: Optimizing Personalized Care Using Economic Studies of Genomic Testing
Fiscal Year: 2014


DESCRIPTION (provided by applicant): The challenge of personalized medicine is knowing when and how to apply screening and diagnostic tests and targeted treatments so that they result improved outcomes and cost-effective investment of resources at a population level. To date, genomic tests have been introduced into practice with scant empirical knowledge about their actual impact on health and economic outcomes, or use in diverse patient subgroups by varying physicians in multiple health care systems. No study has estimated the cost-effectiveness of genomic tests as they are used in the community, or used primary data in a robust US population model to compare real-life cost-effectiveness to analyses using trial data or hypothetical cohorts. Our project will use an innovative multi-criteria decision analysis framework to evaluate the impact of physician, patient, and system factors on the prioritization of competing strategies for the delivery of personalized cancer care in the community. We concentrate on cancer because of the large and growing number of genomic applications for this disease, the potential for major public health impact, and our ability to leverage specialized resources based on NCI's investment in several large research programs we lead. Our approaches are designed to be generalizable to personalized health interventions for other chronic diseases. We will (1) Identify critical factors that influence the cost-effectiveness of genomic testing based on guideline- recommended care vs. usual care without genomic testing, using our validated CISNET multi-cohort population model to evaluate an exemplar gene expression profile test in breast cancer; (2) Describe actual community care, and measure criteria important for decisions about use of genomic tests, using existing electronic records linked with registry data from diverse structures of care in two defined geographic regions, and surveys of a nested sample of 800 patients and their physicians; and (3) Test whether population cost-effectiveness based on actual use and outcomes of genomic testing in community practice is different from that predicted assuming all receive guideline care, and evaluate how the use of multi-criteria decision analysis compared with traditional cost-effectiveness analysis affects the prioritization of strategies. This research will provide a generalizable framework and tools for obtaining evidence on factors affecting the cost-effective use of genomic testing in "real world" community practice. Our results will add an important foundation in data and methods for future economic analyses that inform that the translation of NIH-supported research into practice and address priorities to use personalized medicine to better prevent, screen, diagnose, and treat cancer.


Profits, public health, and patient care: caring for childhood cancer survivors.
Authors: Jayasekera J. , Yeh J. , Graves K. , Mandelblatt J. .
Source: Translational behavioral medicine, 2021-04-07; 11(3), p. 772-774.
PMID: 33595065
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Feasibility of Measuring Preferences for Chemotherapy Among Early-Stage Breast Cancer Survivors Using a Direct Rank Ordering Multicriteria Decision Analysis Versus a Time Trade-Off.
Authors: Panattoni L. , Phelps C.E. , Lieu T.A. , Alexeeff S. , O'Neill S. , Mandelblatt J.S. , Ramsey S.D. .
Source: The patient, 2020 Oct; 13(5), p. 557-566.
PMID: 32447608
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Potential Impact of Cessation Interventions at the Point of Lung Cancer Screening on Lung Cancer and Overall Mortality in the United States.
Authors: Cao P. , Jeon J. , Levy D.T. , Jayasekera J.C. , Cadham C.J. , Mandelblatt J.S. , Taylor K.L. , Meza R. .
Source: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2020 Jul; 15(7), p. 1160-1169.
EPub date: 2020-03-08.
PMID: 32160967
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Simulation of Chemotherapy Effects in Older Breast Cancer Patients With High Recurrence Scores.
Authors: Chandler Y. , Jayasekera J.C. , Schechter C.B. , Isaacs C. , Cadham C.J. , Mandelblatt J.S. .
Source: Journal of the National Cancer Institute, 2020-06-01; 112(6), p. 574-581.
PMID: 31612208
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Health Economics Tools and Precision Medicine: Opportunities and Challenges.
Authors: Veenstra D.L. , Mandelblatt J. , Neumann P. , Basu A. , Peterson J.F. , Ramsey S.D. .
Source: Forum for health economics & policy, 2020-03-05; 23(1), .
EPub date: 2020-03-05.
PMID: 32134729
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Female family members lack understanding of indeterminate negative BRCA1/2 test results shared by probands.
Authors: Himes D.O. , Gibbons D.K. , Birmingham W.C. , Beckstrand R.L. , Gammon A. , Kinney A.Y. , Clayton M.F. .
Source: Journal of genetic counseling, 2019 Oct; 28(5), p. 950-961.
EPub date: 2019-06-14.
PMID: 31199558
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The impact of gene expression profile testing on confidence in chemotherapy decisions and prognostic expectations.
Authors: Panattoni L. , Lieu T.A. , Jayasekera J. , O'Neill S. , Mandelblatt J.S. , Etzioni R. , Phelps C.E. , Ramsey S.D. .
Source: Breast cancer research and treatment, 2019 Jan; 173(2), p. 417-427.
EPub date: 2018-10-10.
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Cost Effectiveness of Gene Expression Profile Testing in Community Practice.
Authors: Chandler Y. , Schechter C.B. , Jayasekera J. , Near A. , O'Neill S.C. , Isaacs C. , Phelps C.E. , Ray G.T. , Lieu T.A. , Ramsey S. , et al. .
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Resource allocation in decision support frameworks.
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Multilevel Influences on Patient-Oncologist Communication about Genomic Test Results: Oncologist Perspectives.
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Source: Journal of health communication, 2018; 23(7), p. 679-686.
EPub date: 2018-08-21.
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Oncologist and organizational factors associated with variation in breast cancer multigene testing.
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Evaluating Frameworks That Provide Value Measures for Health Care Interventions.
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Source: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2017 Feb; 20(2), p. 185-192.
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Breast cancer multigene testing trends and impact on chemotherapy use.
Authors: Ray G.T. , Mandelblatt J. , Habel L.A. , Ramsey S. , Kushi L.H. , Li Y. , Lieu T.A. .
Source: The American journal of managed care, 2016-05-01; 22(5), p. e153-60.
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Expanding access to BRCA1/2 genetic counseling with telephone delivery: a cluster randomized trial.
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