George Goshua, MD, MSc
Research & Publications
The Goshua Lab is the first research program in the United States working at the interface of quantitative decision-analytic modeling and clinical medicine, with an initial focus in hematology-oncology. Any clinical decision where tradeoffs exist is eligible for quantitative modeling and so we fuse state-of-the-art in quantitative decision science with clinical expertise to inform (1) guidelines, (2) health resource allocation, and (3) health policy decisions. For collaborations or to support our research, please e-mail the PI. Lab website to come in Q2 2023 (www.goshualab.com).
Post-Doctoral Fellow: Satoko Ito, MD PhD, Decision Analytic Modeling Lead
Lab members (alphabetical order by last name):
Cecily Allen, MD, Johns Hopkins Hematology '26
Ayesha Butt, MD, Yale Internal Medicine '26
Karthik Chetlapalli, Yale MD '26
Kunal Potnis, Yale Internal Medicine '26
Adriana Purcell, Yale MD-PhD ['22 Entry Class]
Giri Viswanathan, Yale College '25
Christina Waldron, Yale MD '26
Daniel Wang, Yale MD '26
Extensive Research Description
As in 2017, in 2021 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"and "Mirror, Mirror 2021". 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.
Examples of the practical impact of recently published original science at this interface has led to 1. inpatient formulary approval of rituximab for patients with immune thrombotic thrombocytopenic purpura (TTP) in the US hospital setting, 2. clinical optimization of tocilizumab in a supply-limited context in Canada, 3. international debate as to the efficacy, safety, and consequent cost-ineffectiveness of caplacizumab in immune TTP, and 4. gap fill in the American Society of Hematology guidelines for optimal second-line treatment sequencing for patients with chronic immune thrombocytopenia. Ongoing and planned work includes research in alloimmunization, gene therapy, maternal-fetal hematology, complement inhibition, iron deficiency, iron chelation, thrombosis, with a particular focus on the quantitative modeling of health equity considerations in all of these diseases within the United States.
For the most recent examples of embargoed, oral work presented at the 64th American Society of Hematology meeting in New Orleans please see oral presentations at:
https://ash.confex.com/ash/2022/webprogram/Paper169099.html [2022 ASH Press Program Selection]
https://ash.confex.com/ash/2022/webprogram/Paper170003.html [2023 Highlights of ASH for North America]
https://ash.confex.com/ash/2022/webprogram/Paper157460.html [2022 ASH Press Program Selection]
Decision Trees; Hematology; Markov Chains; Quality of Life; Survival Analysis; Health Care Costs; Clinical Decision-Making; Health Equity; Clinical Decision Rules; Low-Value Care
- Apixaban 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.
- Cost‐effectiveness of second‐line therapies in adults with chronic immune thrombocytopeniaGoshua G, Sinha P, Kunst N, Pischel L, Lee AI, Cuker A. Cost‐effectiveness of second‐line therapies in adults with chronic immune thrombocytopenia American Journal Of Hematology 2022, 98: 122-130. PMID: 35147241, PMCID: PMC9365880, DOI: 10.1002/ajh.26497.
- Cost-effectiveness of tocilizumab in severe COVID-19: to see or not to seePischel L, Goshua G. Cost-effectiveness of tocilizumab in severe COVID-19: to see or not to see Clinical Infectious Diseases 2021, 73: ciab459-. PMID: 33999992, PMCID: PMC8194546, DOI: 10.1093/cid/ciab459.
- Accurate accounting of caplacizumab cost effectivenessGoshua G, Prasad V, Lee AI, Bendapudi PK. Accurate accounting of caplacizumab cost effectiveness The Lancet Haematology 2021, 8: e315. PMID: 33894166, DOI: 10.1016/s2352-3026(21)00052-1.
- Cost effectiveness of caplacizumab in acquired thrombotic thrombocytopenic purpuraGoshua G, Sinha P, Hendrickson J, Tormey C, Bendapudi PK, Lee AI. Cost effectiveness of caplacizumab in acquired thrombotic thrombocytopenic purpura Blood 2020, 137: 969-976. PMID: 33280030, PMCID: PMC7918179, DOI: 10.1182/blood.2020006052.
- Reduced fixed dose tocilizumab 400 mg IV compared to weight-based dosing in critically ill patients with COVID-19: A before-after cohort studyStukas S, Goshua G, Kinkade A, Grey R, Mah G, Biggs CM, Jamal S, Thiara S, Lau TTY, Piszczek J, Partovi N, Sweet DD, Lee AYY, Wellington CL, Sekhon MS, Chen LYC. Reduced fixed dose tocilizumab 400 mg IV compared to weight-based dosing in critically ill patients with COVID-19: A before-after cohort study The Lancet Regional Health - Americas 2022, 11: 100228. PMID: 35345649, PMCID: PMC8941850, DOI: 10.1016/j.lana.2022.100228.
- Summiting thrombotic hazards in gliomaGoshua G, Lee A. Summiting thrombotic hazards in glioma Blood 2023, 141: 1245-1246. PMID: 36929442, DOI: 10.1182/blood.2022019020.
- Cost-effectiveness of azacitidine and ivosidenib in newly diagnosed older, intensive chemotherapy-ineligible patients with IDH1-mutant acute myeloid leukemiaBewersdorf J, Patel K, Goshua G, Shallis R, Podoltsev N, Stahl M, Stein E, Huntington S, Zeidan A. Cost-effectiveness of azacitidine and ivosidenib in newly diagnosed older, intensive chemotherapy-ineligible patients with IDH1-mutant acute myeloid leukemia Leukemia & Lymphoma 2022, 64: 454-461. PMID: 36493798, PMCID: PMC9957935, DOI: 10.1080/10428194.2022.2140288.
- Thrombosis questions from the inpatient wardsGoshua G, Bendapudi P, Lee A. Thrombosis questions from the inpatient wards Hematology 2022, 2022: 481-490. PMID: 36485139, PMCID: PMC9819989, DOI: 10.1182/hematology.2022000384.
- Evidence-Based Minireview: Should caplacizumab be used routinely in unselected patients with immune thrombotic thrombocytopenic purpura?Goshua G, Bendapudi P. Evidence-Based Minireview: Should caplacizumab be used routinely in unselected patients with immune thrombotic thrombocytopenic purpura? Hematology 2022, 2022: 491-494. PMID: 36485149, PMCID: PMC9820987, DOI: 10.1182/hematology.2022000412.
- Cost-effectiveness of liposomal cytarabine/daunorubicin in patients with newly diagnosed acute myeloid leukemia.Bewersdorf JP, Patel KK, Goshua G, Shallis RM, Podoltsev NA, Huntington SF, Zeidan AM. Cost-effectiveness of liposomal cytarabine/daunorubicin in patients with newly diagnosed acute myeloid leukemia. Blood 2022, 139: 1766-1770. PMID: 35298594, PMCID: PMC8931513, DOI: 10.1182/blood.2021014401.
- Adenovirus-Based Vaccines and Thrombosis in Pregnancy: A Systematic Review and Meta-analysisPischel L, Patel KM, Goshua G, Omer SB. Adenovirus-Based Vaccines and Thrombosis in Pregnancy: A Systematic Review and Meta-analysis Clinical Infectious Diseases 2022, 75: 1179-1186. PMID: 35134164, PMCID: PMC9383370, DOI: 10.1093/cid/ciac080.
- Immunothrombosis: a COVID‐19 concertoGoshua G, Butt A, Lee AI. Immunothrombosis: a COVID‐19 concerto British Journal Of Haematology 2021, 194: 491-493. PMID: 34114208, DOI: 10.1111/bjh.17666.
- Increased complement activation is a distinctive feature of severe SARS-CoV-2 infectionMa L, Sahu S, Cano M, Kuppuswamy V, Bajwa J, McPhatter J, Pine A, Meizlish M, Goshua G, Chang C, Zhang H, Price C, Bahel P, Rinder H, Lei T, Day A, Reynolds D, Wu X, Schriefer R, Rauseo A, Goss C, O’Halloran J, Presti R, Kim A, Gelman A, Dela Cruz C, Lee A, Mudd P, Chun H, Atkinson J, Kulkarni H. Increased complement activation is a distinctive feature of severe SARS-CoV-2 infection Science Immunology 2021, 6: eabh2259. PMID: 34446527, PMCID: PMC8158979, DOI: 10.1126/sciimmunol.abh2259.
- A neutrophil activation signature predicts critical illness and mortality in COVID-19Meizlish ML, Pine AB, Bishai JD, Goshua G, Nadelmann ER, Simonov M, Chang CH, Zhang H, Shallow M, Bahel P, Owusu K, Yamamoto Y, Arora T, Atri DS, Patel A, Gbyli R, Kwan J, Won CH, Dela Cruz C, Price C, Koff J, King BA, Rinder HM, Wilson FP, Hwa J, Halene S, Damsky W, van Dijk D, Lee AI, Chun HJ. A neutrophil activation signature predicts critical illness and mortality in COVID-19 Blood Advances 2021, 5: 1164-1177. PMID: 33635335, PMCID: PMC7908851, DOI: 10.1182/bloodadvances.2020003568.
- Intermediate‐dose anticoagulation, aspirin, and in‐hospital mortality in COVID‐19: A propensity score‐matched analysisMeizlish ML, Goshua G, Liu Y, Fine R, Amin K, Chang E, DeFilippo N, Keating C, Liu Y, Mankbadi M, McManus D, Wang SY, Price C, Bona RD, Chaar C, Chun HJ, Pine AB, Rinder HM, Siner JM, Neuberg DS, Owusu KA, Lee AI. Intermediate‐dose anticoagulation, aspirin, and in‐hospital mortality in COVID‐19: A propensity score‐matched analysis American Journal Of Hematology 2021, 96: 471-479. PMID: 33476420, PMCID: PMC8013588, DOI: 10.1002/ajh.26102.
- Harmonizing hypercoagulable heterogeneity: Baseline VTE risk in COVID‐19Goshua G, Lee AI. Harmonizing hypercoagulable heterogeneity: Baseline VTE risk in COVID‐19 Research And Practice In Thrombosis And Haemostasis 2021, 5: e12448. PMID: 33537523, PMCID: PMC7845060, DOI: 10.1002/rth2.12448.
- Admission Rothman Index, Aspirin, and Intermediate Dose Anticoagulation Effects on Outcomes in COVID-19: A Multi-Site Propensity Matched AnalysisGoshua G, Liu Y, Meizlish M, Fine R, Amin K, Chang E, Liu Y, McManus D, Petrosan A, Ochoa Chaar C, Chun H, Defilippo N, Neuberg D, Owusu K, Lee A. Admission Rothman Index, Aspirin, and Intermediate Dose Anticoagulation Effects on Outcomes in COVID-19: A Multi-Site Propensity Matched Analysis Blood 2020, 136: 23-24. PMCID: PMC8330288, DOI: 10.1182/blood-2020-143349.
- Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional studyGoshua G, Pine AB, Meizlish ML, Chang CH, Zhang H, Bahel P, Baluha A, Bar N, Bona RD, Burns AJ, Dela Cruz CS, Dumont A, Halene S, Hwa J, Koff J, Menninger H, Neparidze N, Price C, Siner JM, Tormey C, Rinder HM, Chun HJ, Lee AI. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study The Lancet Haematology 2020, 7: e575-e582. PMID: 32619411, PMCID: PMC7326446, DOI: 10.1016/s2352-3026(20)30216-7.
- Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpuraGoshua G, Gokhale A, Hendrickson JE, Tormey C, Lee AI. Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpura Blood Advances 2020, 4: 539-545. PMID: 32045473, PMCID: PMC7013262, DOI: 10.1182/bloodadvances.2019000827.
- Shared Humanity.Goshua G. Shared Humanity. Annals Of Internal Medicine 2017, 167: 359. PMID: 28869981, DOI: 10.7326/m16-2602.
- BreatheGoshua G. Breathe Journal Of General Internal Medicine 2016, 31: 974-975. PMID: 27145759, PMCID: PMC4945569, DOI: 10.1007/s11606-016-3702-6.