About

Dr. Josh Carlson is a Professor in the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute within the School of Pharmacy at the University of Washington. He serves as the Graduate Program Director and is involved in faculty activities related to pharmacy and health policy. Dr. Carlson earned his PhD in Public Health Genetics from the University of Washington in 2007 and completed postdoctoral training in health economics and outcomes research at the same institution from 2007 to 2009. His research focuses on informing healthcare decision making through economic modeling, evidence synthesis, preference assessment, and health policy evaluation. His work spans various diseases, topics, and methodologies, with particular emphasis on economic analysis, precision medicine, and performance-based risk sharing arrangements. Dr. Carlson has diverse formal training in decision modeling, discrete choice experiments, outcomes research, and public health genetics, and his research aims to advance healthcare interventions and policies through rigorous analysis.

Research topics

• Computer Science
• Medicine
• Internal medicine
• Data Mining
• Reliability engineering
• Surgery
• Engineering
• Risk analysis (engineering)
• Oncology
• Statistics
• Systems engineering
• Econometrics
• Intensive care medicine
• Mathematics

Selected publications

• Molecular testing in primary advanced or recurrent endometrial cancer: A cost-effectiveness analysis.

  Journal of Clinical Oncology · 2025-05-28

  articleSenior author

  5598 Background: The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) algorithm is a classification scheme for endometrial cancer (EC) based on sequential testing for DNA mismatch repair deficiency (dMMR), POLE exonuclease domain mutations, and p53 mutations. The cost-effectiveness of ProMisE vs no molecular testing to inform initial systemic treatment choice in patients with stage III/IV primary advanced/recurrent EC (pA/rEC) was assessed from payer and societal perspectives. Methods: A hybrid model comprising a decision tree for molecular classification (ProMisE vs no testing) followed by partitioned survival models (PSM; progression-free disease, progressed disease, and death) was developed. Lifetime costs and outcomes following first-line systemic treatments were estimated using this model. Patients in the no-testing arm were assigned to receive carboplatin-paclitaxel (CP), dostarlimab + CP, pembrolizumab + CP, or hormonal therapy (everolimus/letrozole). Patients in the ProMisE arm were assigned to the same treatments or bevacizumab + CP, according to their molecular profile. Survival functions were derived from published trial results. EQ-5D-5L utility values were sourced from the RUBY trial (NCT03981796). Costs were sourced from US-focused databases and publicly available literature. The base case presented a US third-party payer perspective. A scenario analysis presented a modified societal perspective. Model outcomes were total costs, total life-years (LYs), total quality-adjusted LYs (QALYs), and the incremental cost-effectiveness ratio (ICER) of ProMisE vs no testing. An annual discount rate of 3% per year was applied to future costs and outcomes. Uncertainty was evaluated using one-way (OWSA) and probabilistic sensitivity analyses (PSA). Results: From a third-party payer perspective, total LYs and total QALYs were 5.36 and 4.08, respectively, with ProMisE vs 3.83 and 2.89 with no testing. Total costs were $233,989 with ProMisE vs $155,305 with no testing. Thus, incremental LYs and QALYs were 1.53 and 1.19 greater with ProMisE vs no testing; incremental costs over a lifetime were $78,684 greater with ProMisE. Assuming a cost-effectiveness threshold of $150,000 per QALY gained, ProMisE was cost-effective with an ICER of $66,321 per QALY gained compared with no testing. In the OWSA, ProMisE remained cost-effective over all parameter ranges (±10%). In the PSA, ProMisE was below the threshold of $150,000/QALY for 97.7% of iterations. From a societal perspective, lifetime costs were lower (−$22,973) and QALYs greater with ProMisE vs no testing. Conclusions: ProMisE testing is cost-effective vs no testing when using a $150,000/QALY-gained threshold. Given the heterogeneity of molecular subtypes in stage III/IV pA/rEC, molecular testing enables personalized treatment that is clinically meaningful and high value from payer and societal perspectives.

  PublisherDOI

• Author Reply

  Value in Health · 2025-05-08

  letterSenior author
  PublisherDOI

• The association between new cancer therapy innovations and financial toxicity

  JNCI Journal of the National Cancer Institute · 2025-06-20 · 2 citations

  article

  BACKGROUND: Recent advancements in cancer treatments have improved survival rates, but rising costs associated with these innovations raise concerns about their financial impact on patients. This study investigates the trade-off between improved survival and the financial toxicity over time in advanced non-small cell lung cancer (NSCLC). METHODS: We conducted a retrospective cohort study using linked data from the Western Washington SEER cancer registry and TransUnion credit records, focusing on adults diagnosed with advanced NSCLC, bladder, uterine, head and neck, and liver cancers between 2013 and 2017. Financial toxicity was assessed through major adverse financial events (AFEs), including collections, charge offs, liens, delinquent payments, foreclosures, repossessions, and bankruptcies. Multivariable multinomial logistic regression evaluated trends in a composite outcome of survival and AFEs for NSCLC patients within 2 years post-diagnosis. A falsification test evaluated a negative control group of advanced cancers lacking new therapies. RESULTS: Our study included 6548 patients (mean age 69; 42% female; 86% non-Hispanic White). Two-year survival for NSCLC patients increased from 15.2% to 19.2% between 2013 and 2017 (mean change 4.0%pt, 95% CI = 0.7 to 7.3). The proportion of survivors without AFEs increased by 2.2%pt (95% CI = -0.6 to 5.1), while those alive with major AFEs increased by 1.9%pt (95% CI = 0.02 to 3.6). This trend was absent in the negative control group. CONCLUSIONS: The trade-off between survival gains and increased economic hardships linked to treatment innovations underscores the need to expand our focus beyond clinical outcomes and implement protective measures that ensure healthcare advancements promote population health without inducing financial distress.

  PublisherDOI

• Evaluating Long-Term Health Disparity Impacts of Clinical Algorithms Using a Patient-Level Simulation Framework

  Value in Health · 2025-10-15

  article
  PublisherDOI

• SA39 Cost-Effectiveness of Olanzapine for Cancer Cachexia Management

  Value in Health · 2025-07-01

  articleSenior author
  PublisherDOI

• Real-World Molecular Testing Rates and Patterns in Patients With Primary Advanced or Recurrent Endometrial Cancer in the United States

  JCO Precision Oncology · 2025-03-01 · 2 citations

  article

  PURPOSE: This retrospective cohort study estimated the real-world utilization of biomarker testing among patients with primary advanced/recurrent endometrial cancer (pA/rEC) and characterized testing according to demographic and clinical characteristics. MATERIALS AND METHODS: A nationwide electronic health record-derived deidentified database was used. Records from January 1, 2013, to August 31, 2023, for women age 18 years and older with pA/rEC were searched for DNA mismatch repair (MMR)/microsatellite instability (MSI), human epidermal growth factor receptor 2 (HER2), and estrogen receptor (ER) or progesterone receptor (PR) testing; a subsample data set (advEndo Spotlight) was searched from April 1, 2013, to November 30, 2022, for additional biomolecular testing. Testing rates were reported by index year and molecular marker. Multivariate logistic regression analyses were conducted to identify characteristics associated with testing. RESULTS: The full data set included 2,982 patients, of whom 53% were age 65 years and older; most were non-Hispanic White (56%) and received care in a community setting (73%). The advEndo Spotlight subsample (n = 509) had similar characteristics. From 2013 to 2021, testing for any biomarker increased from 53% to 89% (MMR/MSI, 17% to 81%; ER/PR, 45% to 62%; HER2, 15% to 43%). Patients who received care at an academic versus community facility, had commercial/other insurance versus Medicare/Medicaid, had primary advanced versus recurrent EC, had endometrioid versus nonendometrioid carcinoma, or had no previous surgery as part of primary treatment were more likely to receive testing. CONCLUSION: Molecular testing rates in pA/rEC have increased over time, likely due in part to incorporation of biomarker testing into treatment guidelines. This highlights an unmet need to ensure universal access to testing in patients with pA/rEC. Understanding these factors can inform approaches to increase access to molecular testing and increase testing rates.

  PublisherDOI

• Innovations Versus Health Equity? Effects of Cancer Treatment Advancements on Disparities in Mortality: A Quasi-Experimental Study

  JCO oncology advances. · 2025-08-01 · 1 citations

  articleOpen accessSenior author

  PURPOSE In the past decade, advanced lung cancer and melanoma have witnessed a surge in Food and Drug Administration (FDA)–approved treatment innovations. Yet, the impact of these advancements on population-level survival and survival disparities remains unclear. We aimed to evaluate whether cancer treatment innovations were associated with survival disparities by county-level income. METHODS This quasi-experimental study used data from the SEER registry, including 357,095 adults diagnosed with advanced cancers that experienced significant treatment advancement between 2007 and 2016 (melanoma and non–small cell lung cancer [NSCLC]) and cancers that lacked similar advancements (bladder, uterine, head and neck, and liver cancers). Using a difference-in-difference-in-differences approach, we compared changes in 2-year survival between cancers with and without treatment advancement and quantified survival disparities as the differences in these changes between high-income and low-income counties. RESULTS Between 2007 and 2016, cancer treatment approvals resulted in an adjusted survival increase of 3.7 percentage points (95% CI, 2.7 to 4.6) for NSCLC and 16.8 percentage points (95% CI, 14.5 to 19.2) for melanoma. The approval of epidermal growth factor receptor tyrosine kinase inhibitors and anti–PD-1 immunotherapies for NSCLC was associated with increased survival disparities between high-income and low-income counties by 2.4 percentage points (95% CI, 0.07 to 4.7). The approval of PD-1 inhibitors and BRAF/MEK inhibitors for melanoma was associated with an increase in survival disparity by 6.1 percentage points (95% CI, 0.1 to 12.1). CONCLUSION Although FDA approvals are significantly associated with improved survival in NSCLC and melanoma, they have also exacerbated survival disparities. These findings indicate a possible causal link between new therapeutic innovations and health disparities, emphasizing the need to integrate equity considerations into policies related to drug pricing, coverage, and dissemination to mitigate disparity impacts and to address systemic inequities.

  PublisherDOI

• Evaluating Policies of Expanding Versus Restricting First-Line Treatment Choices: A Cost-Effectiveness Analysis Framework

  Value in Health · 2024-01-06 · 4 citations

  article
  PublisherDOI

• Imetelstat for anemia in lower-risk myelodysplastic syndromes: A summary from the Institute for Clinical and Economic Review’s California Technology Assessment Forum

  Journal of Managed Care & Specialty Pharmacy · 2024-11-29

  articleOpen access

  CLINICAL EFFECTIVENESSWe focused on 2 specific comparisons in this assessment: (1) imetelstat vs best supportive care for patients with lower-risk MDS who are transfusion dependent despite ESAs (overall low, low, or intermediate) or higher risk (high or very high) categories. [4][5]5][6] In lower-risk MDS, approximately 40% of patients require blood transfusions to manage their anemia.Erythropoiesisstimulating agents (ESAs) are the standard first-line treatment, but some patients do not respond, and others may lose efficacy over time. 7Luspatercept (Reblozyl; Bristol Myers Squibb) has been approved by the US Food and Drug Administration (FDA) as a first-line treatment for anemia in patients with lower-risk MDS as well as use after ESA failure in the approximately 35% of patients with RS-positive disease (where luspatercept has been found to be particularly effective). 8or patients with the del(5q) subtype, which makes up approximately 10% of cases, lenalidomide is an effective treatment option. 9Imetelstat (Rytelo; Geron Corporation) was approved by the FDA on June 6, 2024, as a treatment for transfusion-dependent anemia in patients with lower-risk MDS who have not responded to, lost response to, or are ineligible for ESAs. 10 The Institute for Clinical and Economic Review (ICER) conducted a systematic literature review and cost-effectiveness analysis to evaluate the clinical and economic outcomes of imetelstat for anemia in lower-risk MDS.This report presents a summary of our findings and highlights the key policy recommendations Imetelstat for anemia in lower-risk myelodysplastic syndromes:

  PublisherOA PDFDOI

• Atidarsagene autotemcel for metachromatic leukodystrophy

  Journal of Managed Care & Specialty Pharmacy · 2024-02-03 · 6 citations

  articleOpen access
  PublisherOA PDFDOI

Frequent coauthors

• David L. Veenstra

  University of Washington

  102 shared

• Scott D. Ramsey

  University of Washington

  77 shared

• Sean D. Sullivan

  London School of Economics and Political Science

  57 shared

• Steven D. Pearson

  Institute for Clinical and Economic Review

  40 shared

• Anirban Basu

  University of Washington

  38 shared

• Marcia S. Brose

  Thomas Jefferson University Hospital

  37 shared

• Ulrik Lassen

  Copenhagen University Hospital

  37 shared

• Noah Federman

  University of California, Los Angeles

  37 shared

Education

• Ph.D., Public Health Genetics

  University of Washington

• M.S., Public Health Genetics

  University of Washington

Awards & honors

• ISPOR Bernie J. O’Brien new investigator award (2014)