Health economist Amanda Kowalski, a professor of economics and public policy at the University of Michigan and a faculty associate of the Population Studies Center and the Survey Research Center at the Institute for Social Research, received the Willard G. Manning Memorial Award for the Best Research in Health Econometrics June 12 from the American Society of Health Economics (ASHEcon) at their annual conference in St. Louis, Mo.
She won the award for her paper, “Behaviour within a Clinical Trial and Implications for Mammography Guidelines,” published in the Review of Economic Studies.
Mammograms are controversial because they involve tradeoffs, pitting the benefits of early detection against the harms of false positive diagnoses as well as overdiagnosis– detection of cancers that would never have caused symptoms. Mammogram recommendations have weakened worldwide in response to mounting evidence of overdiagnosis and evidence of its costs for women who needlessly undergo therapies such as surgery, chemotherapy, and radiation, and live with the fear of cancer recurrence. The United States Preventive Task Force mammography guidelines for women in their 40s now recommend that women consult with their doctors and receive mammograms as they see fit. In her award-winning paper, Kowalski assesses whether these recommendations target women effectively.
Kowalski addresses this question using data from the Canadian National Breast Screening Study, which follow participants long enough to demonstrate overdiagnosis through examination of breast cancer as a health outcome. Combining the outcome data with observations of mammography behavior– where some women in the control arm receive mammograms and some women in the intervention arm do not– Kowalski finds that women more likely to receive mammograms are healthier and more likely to be overdiagnosed.
“My findings suggest that further weakening of mammography guidelines could provide a rare opportunity to improve health and decrease health spending,” said Kowalski. “It would also make guidelines in the United States more consistent with guidelines in other countries.”
The key to her findings is the connection between the clinical trial data and the econometric methods, Kowalski said. “My work has the potential to be useful beyond the context of mammography because it illustrates how to use behavior within the same clinical trial data to develop guidelines to inform targeting within those guidelines.”
Two graduating economics undergraduates who studied with Kowalski, Meredith Rief and Katherine Kim, worked with Kowalski and research assistant Louis McKinnon to develop a publicly available problem set that teaches the econometric methods in the paper.
Kowalski specializes in bringing together theoretical models and econometric techniques to analyze key health policy questions. Her recent work focuses on designing policies to target insurance expansions and medical treatments to individuals who will benefit from them the most. She is currently studying Covid vaccine equity and medical treatments that save some, but kill others.
Kowalski is the Gail Wilensky Professor of Applied Economics and Public Policy in the University of Michigan Department of Economics and is also Professor of Public Policy in the Gerald R. Ford School of Public Policy, by courtesy. She is also a research associate of the National Bureau of Economic Research (NBER). Kowalski received the ASHEcon medal in 2019; last year, that award recognized the work of colleague Sarah Miller of the Population Studies Center and the Stephen M. Ross School of Business, on the role of health insurance in protection against financial risk. Kowalski has also received the NSF CAREER Award and the Yale Greer Prize for her body of work.
The Willard G. Manning Memorial Award memorializes Will Manning’s contributions to the development and application of econometric methods in health economics by recognizing the best published health economics research in econometric methodology or econometric application.
Story by Tevah Platt, University of Michigan Institute for Social Research
