Date: January 10, 2022
Rachel Breslau (RB): How did you get involved in health economics and outcomes research?
Joshua Cohen (JC): As an undergraduate, I studied applied math. After college, I worked in computer software, but I kept taking courses in decision science. We studied problems like how big you should make a dam. If you make the dam too big, you're spending too much money. Too small, and it's not going to hold back the water. It was uncertainty analysis. After that, I enrolled in a PhD program in decision science at Harvard where I did my thesis on childhood lead exposure. After graduating, I worked in environmental consulting for five years and then I went back to Harvard. Peter Neumann was also there. And in the mid-2000s Peter was pulling together a grant to build an online portal for the Cost-Effectiveness Analysis (CEA) Registry. I helped on the grant proposal, and we won the award. At that point, I was like, I think I'll stick with Peter Neumann. I really learned health economics by reading 70 health economics articles to collect data for the CEA Registry. And then I came to Tufts Medical Center, to CEVR, with Peter.
RB: What are you working on right now?
JC: One of my ongoing projects is to study the benefits of interventions to address COVID. We worked with a modeling group at Tufts University’s Medford campus run by Mike Hughes. They built a COVID model that is mechanistic, so you can see how outcomes change if you modify your assumptions. That means that we can use the model to look at scenarios like the introduction of a pill that prevents people from being hospitalized or at changes in a state’s vaccination rate. Moreover, the model can be calibrated against real world data, such as COVID cases or hospital admissions, and that means it can “learn” to reflect the dynamics of different populations in different locations. Finally, the model is completely open source – so other researchers can see what we have done, and even use our code to help with their own work.
We also wanted to estimate the cost associated with government actions to restrict activities when hospitals fill up with COVID patients. To do that, we looked at high frequency economic data, like credit card transactions. We looked at how that spending changed in response to restrictions states imposed on business activities during the first year of the pandemic. We found that in the U.S., government restrictions imposed in response to the first COVID wave cost $12 billion in lost economic activity.
I’m also working on how incorporating dynamic drug pricing would affect CEA findings – that is, how CEA results might change if we accounted for typical price changes observed over a drug’s life cycle. My paper asks – if we develop some plausible case studies where we model CEAs with and without more realistic lifecycle pricing, would that change the results?
I also taught a clinical and translational science (CTS) course on health technology assessment (HTA) last semester.
RB: What does a day in your life look like?
JC: My work falls into two categories. One is research that I'm doing. And the other is helping, I hope, other people with their research. And the thing I like to focus on is, how do we get the research from our brains into the brains of people we’re trying to reach? I've got a new title that I've given myself, the “chief naïveté officer”. When I’m on a project, the test is: can you get Josh to understand what you’re doing? Because my background is not in health. When I was early in my career and I was lost in a lecture or meeting, I would just hope that eventually I'd understand the material, either by listening more or by reading something on the topic afterwards. I don't have to do that anymore. Which makes me a good stand in for our audiences – because they don't have to do that either. The bottom line is that if we are not making sense to our audience, they're going to start drawing on their paper cups, making grocery lists, and doing anything except listening to us. It’s our responsibility to get our thoughts into their heads.
RB: I'm wondering if there is a memory from your time at CEVR that stands out to you.
JC: CEVR has a big meeting each year in April that a lot of our sponsors attend. At the beginning of the calendar year, we brainstorm ideas for the upcoming meeting. And one year, sort of as a joke, I said, why don't we have high school students from my team come in and debate whether the U.S. should use CEA to set drug prices? [Josh is the debate coach at Newton South High School, and the team has won many state titles and other awards.] And then we did.
We said to our audience, we want you to judge this debate – and set aside your knowledge and opinions about drug prices. Decide the winner based only on what you hear in this round. There were over 100 people in the room. The first debater gets up to speak. She’s like five foot one, the room is quiet, and she just belts out her speech. And the whole debate was like that. It was fast paced, had a lot of clash and sharp cross examination. People loved it. We did have the audience vote afterwards. And two-thirds of them said, yes, we should use CEA to establish drug price limits in the U.S. – even though that’s perhaps not the position they might have thought they would vote for before listening to the round. And the kids - they were on cloud nine; they loved it.
RB: When you were a kid, what did you want to be when you grew up?
JC: I wanted to be a meteorologist. I loved watching the weather on TV. When I was in seventh grade, I collected detailed weather observations — barometric pressure, wind speed and direction, cloud formations, the dew point, and so on – and made forecasts three times a day for a whole year.
In high school, I got into debate. I was always decent at math, but that's not what drives me. Math is a really good tool, and it’s a great way to describe the world and draw inferences. But communicating ideas, that's what I like doing. I am a health economist, which is a mathematical field, and I have a PhD in applied math. But the skill I use every day is not math; it’s debate. It’s thinking about evidence, communication, and responding to arguments. That's what I think I add, hopefully usefully, to what we do here at CEVR.
Rachel Breslau is a research assistant at CEVR. She graduated from Tufts University in 2021 with a BA in Economics and Political Science.
