Roberts Megan C, Dusetzina Stacie B
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.
J Community Genet. 2017 Apr;8(2):141-146. doi: 10.1007/s12687-017-0295-7. Epub 2017 Mar 15.
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.
2013年5月，国际知名名人安吉丽娜·朱莉在一篇广为人知的社论中透露，她接受了BRCA1/BRCA2（BRCA）检测，并随后进行了双侧乳房切除术。围绕名人使用医疗服务的宣传提高了对重要健康问题的认识以及对医疗服务的需求。我们旨在描述朱莉披露前后的BRCA检测趋势、检测后与乳腺癌相关的服务使用情况以及检测报销趋势。利用市场扫描商业理赔数据，采用中断时间序列模型，比较了18至64岁女性在朱莉健康披露前后的BRCA检测趋势。我们使用修正泊松回归来估计BRCA检测后使用医疗服务（手术咨询、乳房切除术、乳房X光检查、磁共振成像、遗传咨询）的风险。2013年1月至2014年10月期间，BRCA检测率从每10万名女性12.5次检测增加到19.0次检测。在朱莉披露后，检测立即增加了约37%（p<0.001）。尽管BRCA检测增加了，但在朱莉披露后，检测后后续服务的使用有所下降。检测的平均保险报销和患者自付费用分别下降了3%和36%。虽然在朱莉披露后基因检测的接受度有所提高，但与BRCA突变相关的后续医疗服务使用却有所下降，这表明名人披露可能与潜在的基因检测过度使用有关。
