Rachel Epstein, MD, MScE, (she/her/hers) is an assistant professor of medicine and pediatrics at Boston Medical Center (BMC), a principal investigator at the Syndemics Lab, and an adult and pediatric infectious diseases physician working with patients living with or at risk for HCV, HIV, and other infectious diseases.
Rachel Epstein is a clinician-scientist with demonstrated experience in analyzing large datasets to inform hepatitis C (HCV), HIV, and substance use disorder interventions. A CHERISH pilot grantee in 2019, she worked closely with her co-investigators Benjamin Linas, CHERISH Population Data and Modeling Core director, and Shashi Kapadia, a CHERISH Research Affiliate and an infectious diseases physician at Weill Cornell Medicine, to analyze claims data from Truven Analytics Marketscan, and investigate the unintended or spillover effects restrictive Medicaid policies have on commercially insured individuals. Since the conclusion of her CHERISH pilot grant experience, Epstein continues to apply economic evaluation methods to her research.
“Health economics is a powerful tool to help reach program administrators and policymakers to point out what interventions are not only clinically effective, but are also feasible to fund with the resources available. Health economics studies can predict realistic strategies to eliminate infectious diseases and reduce negative health outcomes such as opioid overdoses and deaths. The pilot grant experience – the skills learned, the mentorship I received, and the analysis I completed – helped build the foundation for my NIH/NIDA career development award,” Epstein said.
In her latest NIH/NIDA career-development project, Epstein aims to evaluate the clinical effectiveness and cost-effectiveness of introducing interventions in perinatal care to reduce opioid-related mortality and HCV transmission.
What are some critical issues at the intersection of perinatal care, substance use, and HCV?
One important issue is the lack of HCV testing among infants and children. My research is among a growing body of literature demonstrating that less than half of HCV-exposed infants or adolescents diagnosed with opioid use disorder are tested for HCV. In addition, very few children have been treated despite the availability of direct-acting antivirals to cure HCV in children as young as 3 years old.
Pregnant and post-partum women are also populations who need improvements in testing, linkage to care, and treatment. My K-award research aims to determine which areas in the HCV care cascade for pregnant and post-partum women could be most helpful to direct resources into to improve HCV diagnosis and cure.
Who are the peers or mentors that have influenced you or guided you?
Dr. Benjamin Linas is my primary research mentor at Boston University Chobanian and Avedisian School of Medicine/Boston Medical Center and for my K01 career development award. He has been instrumental in helping to shape and grow my research career from the beginning with his guidance on projects and grants.
Dr. Sabrina Assoumou has also been a wonderful career mentor and role model for me as a successful fellow med-peds physician incorporating pediatric and adult infectious diseases research together, and an excellent senior author on an article we published together on adolescent HCV testing in JAMA.
So many more mentors and peers have been critical throughout my career: my fellowship program directors, Drs. Elizabeth Barnett and Tamar Barlam, as well as Drs. Stephen Pelton and Bob Horsburgh. My peers have also been key in giving feedback, moral support, and great research suggestions along the way.
Do you have advice for early career investigators looking to incorporate health economics or modeling into their research?
CHERISH has been an incredible resource for learning how to conduct cost-effectiveness analyses and understand the impact of policy on health outcomes. For me, starting out by participating in cost-effectiveness work others led, taking coursework in decision modeling, attending conferences through CHERISH, and then leading cost-effectiveness analyses has helped build a strong foundation in health economics research. I have applied this perspective and knowledge in my successful applications for a career development award and for the Patrick and Catherine Weldon Donaghue Foundation’s Greater Value Portfolio grant, and I am excited to continue learning and collaborating on new modeling and health economics projects through CHERISH and other avenues.