Date: March 10, 2022
Rachel Breslau (RB): How did you get involved in health economics and outcomes research?
Tara Lavelle (TL): I was looking for research jobs after college with the intention of going to medical school afterwards. I got a job as a research assistant for David Cohen, who at the time was a cardiologist with the Harvard Clinical Research Institute (now the Baim Institute). We were studying the cost-effectiveness of cardiovascular interventions. Eventually it occurred to me that I didn't really want to go to medical school. I really enjoyed the research that I was doing. And it fit with my desire to help people and with the way that I think logically and systematically about things. So I ended up working as a research assistant there for five years, and then I went back to grad school.
RB: How did you come to focus on family-centered outcomes and preferences for health care in your research?
TL: I was taking a decision science class in my master's program and we had a guest lecture from Lisa Prosser, who at the time was a professor in the Department of Population Medicine at Harvard Medical School. She is a decision scientist and health economist who is focused on child health, and how a child’s illness also impacts their family. I was drawn to the fact that in pediatric research there was a lot of interesting work to do on research methods like how to measure preferences of children and their families. After that guest lecture, I talked to Lisa and she offered me a position to work on a project with her related to testing and treating kids for influenza. After that I worked with her for many years and she still continues to be an important mentor to me.
RB: What are you working on right now?
TL: I have two main research interests: mental illness and children’s health. We just finished a project that detailed the barriers to innovation in serious mental illness, and policies that could incentivize more research and effective interventions in this area.
Another project I’m working on is an evaluation of the cost-effectiveness of genomic sequencing to diagnose children with suspected genetic conditions. The question is whether genomic sequencing, which is a relatively expensive but more accurate, one-time test, is cost-effective compared to a series of less expensive but less accurate lab tests and procedures?
We are about to publish a modeling study which shows that genomic sequencing may be cost-effective for infants, but not for older children. We had to make a lot of assumptions based on the literature to populate our model. Now, in collaboration with clinicians at Tufts Medical Center, we are collecting our own primary data on genomic sequencing that we can use for cost-effectiveness studies. We are collecting health services use and quality of life data for infants from the time they undergo sequencing through one year of age, as well as, quality of life data for their parents.
We’re also working on a project about grief in parents who have lost a child and whether outcomes related to grief should be incorporated into economic evaluations. We're going to survey parents who lost a child to spinal muscular atrophy to quantify their lost productivity and quality of life. After we finish the study, we'll convene a panel to engage different health economists and discuss the results and recommendations in this area going forward. Some health economists may say there's no reason to include those outcomes in cost-effectiveness analyses – for example, why would an insurer pay for a parent to avoid grief? But then others will argue if you care about societal benefits, these are clearly important outcomes to include.
RB: What are you most proud of in your career?
TL: I'm really proud of the relationships that I've built with people in this field, and how many of them have not just become colleagues, but really good friends. I think the close knit community in health economics and decision science makes it a really rewarding field to work in.
RB: What advice do you have for students or others who are new to health economics and outcomes research?
TL: Your path does not have to be linear. I think sometimes what attracts all of us to this field is that we're very analytical thinkers and we really want everything to progress logically, but that's just not the way things usually work. You may decide that you want to explore other areas of study. Don’t be afraid of taking alternative paths. After I finished my PhD and post-doctoral fellowship, I went to the RAND Corporation for two years. I was sure that I was going to spend the rest of my career there. But when this job came up at CEVR, it presented a new opportunity. But my experience at RAND continues to influence the way that I think about research and its potential impact on health policy.
RB: When you were a kid, what did you want to be when you grew up?
TL: I wanted to be a pediatrician. I still have a drawing I made in kindergarten of me as a doctor, taking care of a baby. And again, it wasn't until I realized how much I was enjoying health economic research that I changed my career path. But it’s probably the reason that I do so much pediatric research now.
RB: What do you do when you're not doing health economics and outcomes research?
TL: I like to exercise, I've run several marathons, and I've gotten back into running recently. Before the pandemic, I played in an Irish music session at a restaurant in Somerville. The session was for beginners— I’m learning to play the Irish tin whistle. Because my parents are from Ireland, and I grew up Irish step dancing, I’ve always really enjoyed Irish culture and music.
Rachel Breslau is a research assistant at CEVR.