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George Goshua, MD, MSc

Assistant Professor of Medicine (Hematology); Classical, Hematology

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George Goshua, MD, MSc
Goshua Lab

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Research Summary

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]

Coauthors

Research Interests

Decision Trees; Hematology; Markov Chains; Quality of Life; Survival Analysis; Health Care Costs; Clinical Decision-Making; Health Equity; Clinical Decision Rules; Low-Value Care

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Net Monetary Benefit Distributions in Guideline-Recommended Second-Line Treatment for Patients Living with Chronic ITP

Full, most recent original science manuscript available at: https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.26497

Selected Publications

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