title: The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use.
abstract: In May 2013, an internationally renowned celebrity-Angelina Jolie-disclosed her receipt of BRCA1/BRCA2 (BRCA) testing and subsequent double mastectomy in a highly publicized editorial. Publicity surrounding celebrity health services use increases awareness of important health issues and demand for health services. We aimed to describe BRCA testing trends before and after Jolie's disclosure, breast cancer-related services use following testing, and test reimbursement trends. MarketScan Commercial Claims data were used to compare trends in BRCA testing before and after Jolie's health disclosure using an interrupted time series model among women aged 18-64. We used modified Poisson regression to estimate risks for health services use (surgical consult, mastectomy, mammography, magnetic resonance imaging, genetic counseling) following BRCA testing. BRCA testing rates increased from 12.5 to 19.0 tests/100,000 women between January 2013 and October 2014. Immediately following Jolie's disclosure, testing increased by approximately 37% (p < 0.001). Although BRCA testing increased, use of post-testing follow-up services declined after Jolie's disclosure. Mean insurance reimbursement and patient out-of-pocket spending on the test decreased by 3 and 36%, respectively. While genetic testing uptake increased following Jolie's disclosure, subsequent health services use associated with BRCA mutations declined, suggesting that celebrity disclosures may be associated with potential genetic testing overuse.
authors.affiliation: Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA. megan.roberts@nih.gov.|UNC Lineberger Comprehensive Cancer Center, 101 Manning Dr, Chapel Hill, NC, 27514, USA. megan.roberts@nih.gov.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Roberts
authors.affiliation: Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, 135 Dauer Drive 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA.|UNC Lineberger Comprehensive Cancer Center, 101 Manning Dr, Chapel Hill, NC, 27514, USA.|Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Kerr Hall, Room 2203, Chapel Hill, NC, 27599-7573, USA.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599-7590, USA.
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
keywords: Breast cancer; Costs; Genetic testing; Health services use