George Goshua, MD, MSc, FACP
Assistant Professor of Medicine (Hematology)Cards
About
Research
Overview
As in 2017 and 2021, in 2024 the United States again ranked #11/11 both on overall performance and across several domains of health care system performance in The Commonwealth Fund's reports "Mirror, Mirror 2017", "Mirror, Mirror 2021", and "Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System". These rankings are despite the known, decades-long breakaway #1 global ranking in healthcare spending as percentage of GDP. Our consistent #11/11 rankings in the domains of Access (i.e., affordability and timeliness), Equity (i.e., difference between low- and high-income individuals), and Healthcare Outcomes (i.e., population health, mortality amenable to health care, disease-specific health outcomes) are particularly amenable to resource allocation optimization. That is, delivering affordable and equitable care at the right time to the right individuals. Decision analytic modeling allows an explicit quantification of effect estimates, precision intervals and uncertainty present in any given medical decision where tradeoffs are present. The United States' clinical hematologic-oncologic space is particularly rife with new, expensive therapeutic offerings, many times with unclear effect on quality-of-life, and this is where our laboratory fuses methodologic and clinical expertise. For practical impact of, and research accolades for, our lab's work please visit us at www.goshualab.com.
Medical Research Interests
Clinical Decision Rules; Clinical Decision-Making; Decision Trees; Health Care Costs; Health Equity; Hematology; Low-Value Care; Markov Chains; Quality of Life; Survival Analysis
Public Health Interests
Cancer; Chronic Diseases; Clinical Guidelines; Health Care Financing; Health Economics; Maternal & Child Health; Modeling; Women's Health; Pharmacoepidemiology
Publications
Featured Publications
Cost‐effectiveness of sutimlimab in cold agglutinin disease
Ito S, Wang D, Purcell A, Chetlapalli K, Lee A, Cuker A, Goshua G. Cost‐effectiveness of sutimlimab in cold agglutinin disease. American Journal Of Hematology 2024, 99: 1475-1484. PMID: 38733355, DOI: 10.1002/ajh.27358.Peer-Reviewed Original ResearchPrimary cold agglutinin diseaseCold agglutinin diseaseStandard-of-careIncremental cost-effectiveness ratioUS willingness-to-pay thresholdRare autoimmune hemolytic anemiaPhase 3 studyWillingness-to-pay thresholdsAutoimmune hemolytic anemiaTime-limited treatmentHuman monoclonal antibodyCold-reactive antibodiesBinding to red blood cellsFollow-up dataCost-effectiveness ratioComplement-mediated hemolysisDeterministic sensitivity analysisHealth resource utilizationProbabilistic sensitivity analysesTransfusion-dependentClinical remissionTransfusion supportImprove quality of lifeRed blood cellsHemolytic anemiaCancer research is not correlated with driver gene mutation burdens
Mendiratta G, Liarakos D, Tong M, Ito S, Ke E, Goshua G, Stites E. Cancer research is not correlated with driver gene mutation burdens. Med 2024, 5: 832-838.e4. PMID: 38908369, DOI: 10.1016/j.medj.2024.05.013.Peer-Reviewed Original ResearchCancer patient populationCancer researchCancer research effortsResearch allocation decisionsNational InstitutePatient populationResearch fundingBurdenBurden of mutationsFunding decisionsCancerGenetic driversGene mutation burdenFunding amountFundingGenetic drivers of cancerAllocation decisionsCancer-associated genesEpidemiologyDrivers of cancerMutational burdenBaselineEffortsFactorsBalance of prioritiesDecreasing alloimmunization‐specific mortality in sickle cell disease in the United States: Cost‐effectiveness of a shared transfusion resource
Ito S, Pandya A, Hauser R, Krishnamurti L, Stites E, Tormey C, Krumholz H, Hendrickson J, Goshua G. Decreasing alloimmunization‐specific mortality in sickle cell disease in the United States: Cost‐effectiveness of a shared transfusion resource. American Journal Of Hematology 2024, 99: 570-576. PMID: 38279581, DOI: 10.1002/ajh.27211.Peer-Reviewed Original ResearchSickle cell diseaseDelayed hemolytic transfusion reactionQuality-adjusted life expectancyAlloimmunized patientsPatient populationRed blood cell alloimmunizationCell diseaseCost-effective interventionMedical expenditure of patientsHealth system perspectiveExpenditure of patientsIncremental cost-effectiveness ratioHemolytic transfusion reactionsUnited StatesMarkov cohort simulationCost-effectiveAverage patient populationCost-effectiveness ratioBirth cohortAnalytical time horizonAntibody historyCohort simulationTransfusionTransfusion reactionsLife expectancyDistributional Cost-Effectiveness of Equity-Enhancing Gene Therapy in Sickle Cell Disease in the United States.
Goshua G, Calhoun C, Ito S, James L, Luviano A, Krishnamurti L, Pandya A. Distributional Cost-Effectiveness of Equity-Enhancing Gene Therapy in Sickle Cell Disease in the United States. Annals Of Internal Medicine 2023, 176: 779-787. PMID: 37247420, PMCID: PMC10370480, DOI: 10.7326/m22-3272.Peer-Reviewed Original ResearchCost-effectiveness of prophylaxis with recombinant vs plasma-derived VWF in severe von Willebrand disease in the United States
Waldron C, Ito S, Wang D, Allen C, Viswanathan G, Bona R, Cuker A, Goshua G. Cost-effectiveness of prophylaxis with recombinant vs plasma-derived VWF in severe von Willebrand disease in the United States. Blood 2024, 143: 2332-2335. PMID: 38635764, PMCID: PMC11862817, DOI: 10.1182/blood.2024024209.Peer-Reviewed Original ResearchCost-effectiveness of bevacizumab therapy in the care of patients with hereditary hemorrhagic telangiectasia
Wang D, Ito S, Waldron C, Butt A, Zhang E, Krumholz H, Al-Samkari H, Goshua G. Cost-effectiveness of bevacizumab therapy in the care of patients with hereditary hemorrhagic telangiectasia. Blood Advances 2024, 8: 2835-2845. PMID: 38537061, PMCID: PMC11176968, DOI: 10.1182/bloodadvances.2024012589.Peer-Reviewed Original ResearchIncremental net monetary benefitHereditary hemorrhagic telangiectasiaStandard-of-careBevacizumab therapyWillingness-to-payNet monetary benefitHemorrhagic telangiectasiaWillingness-to-pay thresholdsStandard-of-care strategiesCare of patientsCost-effectiveness analysisAnti-VEGF bevacizumabSystemic antiangiogenic therapyCurrent standard-of-careMonetary benefitsTime horizonFormulary placementHealthcare resource utilizationStandard of careLifetime time horizonPatient quality-of-lifeScenario analysisProbabilistic sensitivity analysesIV bevacizumabAnti-VEGFCost-effectiveness of rapid vs in-house vs send-out ADAMTS13 testing for immune thrombotic thrombocytopenic purpura
Allen C, Ito S, Butt A, Purcell A, Richmond R, Tormey C, Krumholz H, Cuker A, Goshua G. Cost-effectiveness of rapid vs in-house vs send-out ADAMTS13 testing for immune thrombotic thrombocytopenic purpura. Blood Advances 2024, 8: 2279-2289. PMID: 38502197, PMCID: PMC11116991, DOI: 10.1182/bloodadvances.2024012608.Peer-Reviewed Original ResearchImmune thrombotic thrombocytopenic purpuraPLASMIC scoreThrombotic thrombocytopenic purpuraThrombocytopenic purpuraADAMTS13 testingIncremental net monetary benefitPer-patient cost savingsTherapeutic plasma exchangeBase-case analysisMarkov cohort simulationProbabilistic sensitivity analysesAmount of QALYEmpirical therapyADAMTS13 assaysPlasma exchangeEmpirical treatmentCaplacizumabFRET-based assayPrimary outcomePatientsNet monetary benefitCohort simulationCost-effectiveness evaluationPurpuraTesting strategiesNapkin math can change the world
Goshua G. Napkin math can change the world. Science 2023, 382: 657-657. PMID: 37943923, DOI: 10.1126/science.adk8633.Peer-Reviewed Original ResearchCost‐effectiveness of prophylactic emicizumab versus prophylactic recombinant factor VIII in patients with moderate or mild hemophilia A without inhibitors in the United States
Potnis K, Viswanathan G, Bona R, Ito S, Kempton C, Pandya A, Krumholz H, Goshua G. Cost‐effectiveness of prophylactic emicizumab versus prophylactic recombinant factor VIII in patients with moderate or mild hemophilia A without inhibitors in the United States. American Journal Of Hematology 2023, 98: e247-e250. PMID: 37401660, DOI: 10.1002/ajh.27014.Peer-Reviewed Original ResearchApixaban at Apex? Aligning Drug Pricing With Value in Cancer-Associated Thrombosis.
Ito S, Goshua G. Apixaban at Apex? Aligning Drug Pricing With Value in Cancer-Associated Thrombosis. Annals Of Internal Medicine 2022, 176: 125-126. PMID: 36571840, DOI: 10.7326/m22-3404.Peer-Reviewed Original Research
Academic Achievements & Community Involvement
Clinical Care
Overview
George Goshua, MD, MSc, FACP, is a physician-scientist who specializes in hematology, diagnosing and treating various blood disorders, such as thrombosis and anemia.
Dr. Goshua runs the first health decision science laboratory focused on hematology-oncology outcomes in the United States. His research has been repeatedly awarded by the leading hematology societies, the NOMIS Foundation, and Science Magazine.
Dr. Goshua is an assistant professor of medicine at Yale School of Medicine.
Clinical Specialties
Hematology
News & Links
Media
- Full, most recent original science manuscript available at: https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.26497
News
- December 18, 2024
Yale research advances presented at American Society of Hematology annual meeting
- December 11, 2024Source: Everyday Health
New Study Makes Case for Iron Deficiency Screening for Many Women
- December 09, 2024Source: Healio
Higher ferritin threshold cost-effective for diagnosing, treating iron deficiency
- December 07, 2024Source: MSN
Drug offers cost-effective protection for newborns with genetic bleeding disorder