The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use
- 250 Downloads
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.
KeywordsGenetic testing Breast cancer Costs Health services use
This project was unfunded. Dr. Roberts was funded by the UNC Lineberger Cancer Control Education Program (CCEP) (R25 CA57726). Dr. Dusetzina receives salary support from the BIRCWH K12 Program and the North Carolina Translational and Clinical Sciences Institute (UL1TR001111).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
This article does not contain any studies with human or animal subjects performed by the any of the authors.
- Andersen M (1995) Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior: 1–10Google Scholar
- Armstrong J et al. (2015) Utilization and outcomes of BRCA genetic testing and counseling in a national commercially insured population: the ABOUT study JAMA oncology:1–10 doi: 10.1001/jamaoncol.2015.3048
- Desai S, Jena AB (2016) Do celebrity endorsements matter? Observational study of BRCA gene testing and mastectomy rates after Angelina Jolie’s New York Times editorial BMJ 355: i6357 doi.org/10.1136/bmj.i6357
- Evans DG et al. (2014) The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services Breast Cancer Res 16:442 doi: 10.1186/s13058–014–0442-6
- Jagsi R et al (2015) Concerns about cancer risk and experiences with genetic testing in a diverse population of patients with breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33:1584–1591. doi: 10.1200/JCO.2014.58.5885 CrossRefGoogle Scholar
- Jolie A (2013) My medical choice. The New York Times Company, New YorkGoogle Scholar
- Noar SM, Althouse BM, Ayers JW, Francis DB, Ribisl KM (2015) Cancer information seeking in the digital age: effects of Angelina Jolie’s prophylactic mastectomy announcement. Medical decision making : an international journal of the Society for Medical Decision Making 35:16–21. doi: 10.1177/0272989X14556130 CrossRefGoogle Scholar
- Thackeray R, Burton SH, Giraud-Carrier C, Rollins S, Draper CR (2013) Using Twitter for breast cancer prevention: an analysis of breast cancer awareness month Bmc Cancer 13 doi:Unsp 508 10.1186/1471–2407–13-508
- Truven Health Analytics (2015) Databases and online tools. http://truvenhealth.com/your-healthcare-focus/life-sciences/data-databases-and-online-tools. Accessed 11 Sep 2015