Do Celebrity Endorsements Matter? Observational Study of BRCA Gene Testing and Mastectomy Rates after Angelina Jolie's New York Times Editorial

Abstract OBJECTIVE:  To examine the effect on BRCA testing and mastectomy rates of a widely viewed 2013 New York Times editorial by public figure Angelina Jolie that endorsed BRCA testing and announced Jolie's decision to undergo preventive mastectomy. DESIGN:  Observational study with difference-in-difference analysis. SETTING:  Commercially insured US population. PARTICIPANTS:  Women aged 18-64 years with claims in the Truven MarketScan commercial claims database (n=9 532 836). MAIN OUTCOME MEASURES:  Changes in BRCA testing rates in the 15 business days before versus after 14 May 2013 (editorial date) compared with the change in the same period in 2012; mastectomy rates in the months before and after publication, both overall and within 60 days of BRCA testing among women who were tested; national estimates of incremental tests and expenditures associated with Jolie's article in the 15 days after publication. RESULTS:  Daily BRCA test rates increased immediately after the 2013 editorial, from 0.71 tests/100 000 women in the 15 business days before to 1.13 tests/100 000 women in the 15 business days after publication. In comparison, daily test rates were similar in the same period in 2012 (0.58/100 000 women in the 15 business days before 14 May versus 0.55/100 000 women in the 15 business days after), implying a difference-in-difference absolute daily increase of 0.45 tests/100 000 women or a 64% relative increase (P