Showing posts sorted by relevance for query Pathak. Sort by date Show all posts
Showing posts sorted by relevance for query Pathak. Sort by date Show all posts

Monday, December 8, 2014

New York City high school choice: market design in the NY Times

The NY Times has a nice article on the high school application process, and how it arose, with particular attention to the work that Atila Abdulkadiroglu and Parag Pathak and I did with Neil Dorosin, when he worked for the New York City Department of Education. (We've since worked to help bring school choice to other cities, through IIPSC...)

How Game Theory Helped Improve New York City High School Application Process
By TRACY TULLIS  DEC. 5, 2014

Here's how the article begins:

"Tuesday was the deadline for eighth graders in New York City to submit applications to secure a spot at one of 426 public high schools. After months of school tours and tests, auditions and interviews, 75,000 students have entrusted their choices to a computer program that will arrange their school assignments for the coming year. The weeks of research and deliberation will be reduced to a fraction of a second of mathematical calculation: In just a couple of hours, all the sorting for the Class of 2019 will be finished.

"To middle-school students and their parents, the high-school admissions process is a grueling and universally loathed rite of passage. But as awful as it can be, it used to be much worse. In the late 1990s, for instance, tens of thousands of children were shunted off to schools that had nothing going for them, it seemed, beyond empty desks. The process was so byzantine it appeared nothing short of a Nobel Prize-worthy algorithm could fix it.

"Which is essentially what happened.

"About a decade ago, three economists — Atila Abdulkadiroglu (Duke), Parag Pathak (M.I.T.) and Alvin E. Roth (Stanford), all experts in game theory and market design — were invited to attack the sorting problem together. Their solution was a model of mathematical efficiency and elegance, and it helped earn Professor Roth a Nobel Memorial Prize in Economic Science in 2012.

"Before the redesign, the application process was a mess. Or, as an economist might say, it was an example of a congested market. Each student submitted a wish list of five schools. Some of them would be matched with one of their choices, and thousands — usually the higher-performing ones — would be matched with more than one school, giving them the luxury of choosing. Nearly half of the city’s eighth graders — many of them lower-performing students from poor families — got no match at all. That some received surplus offers while others got none illustrated the market’s fundamental inefficiency.

"Thousands of unlucky teenagers wound up waiting through the summer to get placed, only to be sent to schools they had not listed at all. And those schools, Professor Pathak discovered in a recent analysis, were “worse in all dimensions” — including student achievement, graduation rate and college admissions — than the schools the students had asked to attend."
*********
The article goes on to describe the deferred acceptance algorithm and some other matters. One nice thing about the story is that it makes clear that this was an effort that involved lots of people--not every newspaper account manages to make that point.













I ended up writing about the NYC school project at somewhat greater length in my forthcoming book, which should be coming out in June, if the creeks don't rise.

Saturday, June 8, 2019

Matching in Practice Workshop in October, in Gothenburg, with Parag Pathak. Call for papers.

The 16th Matching in Practice Workshop will be in Gothenburg. The workshop will begin with lunch (12pm) on the 4th of October finishing early afternoon 5th of October (around 4pm), 2019.
The workshop will bring together researchers working on the various aspects of assignment and matching in education, labour and related markets, with a view to actively foster interactions between the various approaches used in this area of research (theory, experiments, analysis of field data, policy/market design) and to share expertise on the actual functioning of these markets in Europe.

The workshop will include presentations from presenters of selected papers, a keynote delivered by Parag Pathak (Massachusetts Institute of Technology) and a policy roundtable on “School choice in practice”, which will bring together policy makers and practitioners.
Interested participants should submit their papers to mip2019@economics.gu.se before 15 August 2019. The programme will be announced shortly afterwards.

Keynote speakers

Parag Pathak, Professor of Economics, Massachusetts Institute of Technology

Participants

Researchers working on the various aspects of assignment and matching, primarily in (but not limited to) education and related labour markets are invited to attend the workshop. There is no participation fee. Travel and accommodation expenses can only be covered for presenters of selected papers. PhD students or early stage researchers who would like to participate the workshop can contact us for possible financial support for travel and accommodation.

Practicalities

The conference will take place at the School of Business, Economics and Law (Handelshögskolan), Vasagatan 1, Gothenburg.

Scientific Committee

Thilo Klein (ZEW Mannheim), Alex Westkamp (University of Cologne), Li Chen (University of Gothenburg), Joseph Vecci (University of Gothenburg).

Important dates

15 August: Deadline for submission
1 September: Notification about acceptance
3 September: Registration deadline

Sunday, July 1, 2018

Ariel Pakes gives the Arrow Lecture in Jerusalem

If you're in Jerusalem tomorrow, you have a chance to hear Ariel Pakes' Arrow Lecture:

17:00-18:00 Ariel Pakes, Arrow lecture:
Learning and Equilibrium in A New Market

It is part of

The 29th Jerusalem Summer School of Economics

Industrial Organization

Event date: June 26 - July 5, 2018 

Organizers:
    Eric Maskin, General Director (Harvard University)
    Ariel Pakes, Codirector (Harvard University)
    Elchanan Ben-Porath,Codirector (The Hebrew University)


    Industrial Organization studies how markets are structured and the way they respond to changes in conditions (e.g., to policy revisions). The field draws heavily on both theory and empirical work, and both will be amply represented in the Summer School. We will focus on several topics of current research interest: vertical markets, allocation in markets without prices, market dynamics, and regulation.

      
    List of speakers:
    NAMEAFFILIATIONEMAILTOPICS
    Nikhil AgarwalMassachusetts Institute of Technologyagarwaln@mit.eduThe analysis of centralized market allocation mechanisms
    John AskerThe University of Californiajohnaskecr@econ.ucla.eduThe analysis of regulation
    Alon Eizenberg The Hebrew University of Jerusalem      aloneiz@mscc.huji.ac.ilThe analysis of regulation
    Myrto KalouptsidiHarvard University myrto@fas.harvard.eduThe analysis of market dynamics
    Robin LeeHarvard Universityrobinlee@fas.harvard.eduThe   analysis of   vertical markets
    Eric Maskin         Harvard Universityemaskin@fas.harvard.edu The analysis of market dynamics
    Ariel PakesHarvard Universityapakes@fas.harvard.eduThe analysis of market dynamics
    Parag PathakMassachusetts Institute of Technologyppathak@mit.eduThe analysis of centralized market allocation mechanisms
    Mike WhinstonMassachusetts Institute of Technologywhinston@mit.eduThe analysis of vertical markets
    Ali YurukogluStanford Universityayurukog@stanford.eduThe analysis of regulation
Here's a link to the full program.

There will be several sessions on matching markets:
Wednesday, July 4
9:30-11:00 Parag Pathak: Introduction to Matching Theory
11:00-11:30 Coffee Break
11:30-13:00 Nikhil Agarwal: Revealed Preference for Matching Markets

Thursday, July 5
9:30-11:00 Parag Pathak: Market Design Meets Research Design
11:00-11:30 Coffee break

11:30-13:00 Nikhil Agarwal: The Organization of Organ Markets

Monday, January 14, 2013

Josh Angrist and Parag Pathak on charter schools

A profile of MIT economist Josh Angrist in the MIT Technology Review discusses, among other things, some of his work on schools with Parag Pathak: The Natural Experimenter


"How far Angrist can take this research may depend on how many school districts will share useful data with him. Boston and Massachusetts, he says, are unusual in that "we have a great data infrastructure and wonderful coöperation with the city, the schools, and the state."

"That openness allowed him, Pathak, and other collaborators to produce some recent papers that he considers among his best. Boston has used a lottery system to determine which interested students will attend charter schools; when the number of applicants for a school exceeds the space available, the researchers are able to compare the performance of students accepted to a charter school with that of equally motivated students who were not chosen. In a 2009 report, they found that certain Boston charter schools had produced an average gain of roughly 15 percentile points for middle-school students on the state math exams.

"Two years later, however, Angrist and colleagues found that in Massachusetts districts outside Boston, charter-­school students did no better on average than students at other public schools. Angrist thinks charter schools may be too different from one another to justify sweeping conclusions about whether they provide better education, even though the best ones seem to adhere to the formula of extended instruction time, a focus on core math and reading skills, and an emphasis on good behavior."

Wednesday, December 30, 2020

A hard (theoretical) look at school choice, in the AER by Chris Avery and Parag Pathak

 What are some of the difficulties that might hamper school choice from achieving educational equality (or at least substantially reducing inequality)?  Here's a model by Chris Avery and Parag Pathak.  The theoretical intuitions of top experts in college and school assignments are the sort of thing that can keep you awake at night.  In a sentence, if school choice narrows the quality gap between the best and worst municipal schools, it may also narrow the gap in housing prices, and higher housing prices at the low end may drive poorer families to move to other school districts, just as lower quality at the high end drives richer families to suburbs with excellent schools. ("White flight" has been the subject of many papers, so the issue being raised here is that an improvement at the low end of school quality may also raise prices of less expensive housing and drive out poorer residents.)

The Distributional Consequences of Public School Choice  by Christopher Avery and Parag A. Pathak AMERICAN ECONOMIC REVIEW, VOL. 111, NO. 1, JANUARY 2021, (pp. 129-52)

"Abstract: School choice systems aspire to delink residential location and school assignments by allowing children to apply to schools outside of their neighborhood. However, choice programs also affect incentives to live in certain neighborhoods, and this feedback may undermine the goals of choice. We investigate this possibility by developing a model of public school and residential choice. School choice narrows the range between the highest and lowest quality schools compared to neighborhood assignment rules, and these changes in school quality are capitalized into equilibrium housing prices. This compressed distribution generates an ends-against-the-middle trade-off with school choice compared to neighborhood assignment. Paradoxically, even when choice results in improvement in the lowest-performing schools, the lowest type residents need not benefit."


"Our analysis contributes to a recent literature on school choice mechanisms, which has focused on the best way to assign pupils to schools given their residential location in a centralized assignment scheme. In particular, research has examined the best way to fine-tune socioeconomic or income-based criteria in choice systems. Cities have now experimented with complex school choice tie-breakers in an effort to achieve a stable balance (Kahlenberg 2003). 17 By incorporating feedback between residential and school choices, our model suggests that analysis of school assignment that does not account for possible residential resorting may lead to an incomplete understanding about the distributional consequences of school choice.

"A common rationale for school choice is to improve the quality of school options for disadvantaged students. But, our analysis shows that feedback from residential choice can undercut this approach, for if a school choice plan succeeds in narrowing the range between the lowest and highest quality schools, that change should compress the distribution of house prices in that town, thereby providing incentives for the lowest and highest types to exit from the town’s public schools. This intuition extends to the idealized case of a symmetric model of many towns and partisans, where each town adopts school choice and all schools within a given town have the same quality. Although there is an equilibrium in this idealized model where schools in all towns have the same quality, this equilibrium would likely be unstable, and instead we would expect to observe an equilibrium with differentiation of school qualities and housing prices across towns. That is, the within-town diversity observed in equilibrium under neighborhood assignment could be replicated in cross-town diversity under school choice.

A broader implication of our model is that systemic changes beyond the details of the school assignment system may be necessary to reduce inequalities in educational opportunities."

Monday, November 18, 2019

Interview with Parag Pathak on schools, and market design

From Business Insider:
Parents choosing high schools for their kids place more value on the students already enrolled than on the school's effectiveness, according to a study by MIT economist Parag Pathak

"A solution to school matching might be attainable, but the bigger challenge remains. "It's a success in terms of matching systems getting out there," Pathak said. "But it shines a spotlight on bigger problem - the scarcity of good schools."
...
"The rise of "market-design economics" has attracted a new type of person to the profession, he said. "Our folks are much more humble. We really like to get our hands dirty from very real problems," he added. "The mindset is more of an engineer — how would we put those ideas to use in actually building something in society?"

Monday, July 8, 2013

Matching with couples in large markets: Kojima, Pathak and Roth

Fuhito Kojima, Parag Pathak and I have a paper coming out that suggests a beginning of an answer to the empirical puzzle presented by the fact that the many annual labor matching markets with couples that use the Roth-Peranson algorithm overwhelmingly find stable matchings, even though in principle they might fail to exist.  In large markets with short preference lists and without too many couples, the answer seems to be related to the fact that there remain sufficiently many unfilled positions so that vacancy chains are more likely to end than to cycle.

Here's the paper:
Kojima, Fuhito, Parag A. Pathak, and Alvin E. Roth, “Matching with Couples: Stability and Incentives in Large Markets,” April 2010, revised April 2013, Quarterly Journal of Economics, forthcoming.

Abstract: Accommodating couples has been a longstanding issue in the design of centralized labor market clearinghouses for doctors and psychologists, because couples view pairs of jobs as complements. A stable matching may not exist when couples are present. This paper's main result is that a stable matching exists when there are relatively few couples and preference lists are sufficiently short relative to market size. We also discuss incentives in markets with couples. We relate these theoretical results to the job market for psychologists, in which stable matchings exist for all years of the data, despite the presence of couples.

Wednesday, November 29, 2017

The welfare effects of centralized school choice in NYC, by Abdulkadiroglu, Agarwal and Pathak in the AER

The Abdulkadiroglu, Agarwal and Pathak paper on the effects of school choice in NYC has now come out in the December 2017 AER ( 107(12): 3635–3689).

They find substantial welfare effects in moving from NYC's old decentralized high school choice system (in which individual schools made uncoordinated acceptance decisions, so some students received multiple offers while others got none) to the stable matching system (using the deferred acceptance algorithm with single tie-breaking) now used. They don't find big gains from trying to reach a student optimal stable matching by revising the tie-breaking decisions.

The Welfare Effects of Coordinated Assignment:Evidence from the New York City High School Match
By Atila Abdulkadiroglu, Nikhil Agarwal, and Parag A. Pathak

"Coordinated  single-offer  school  assignment  systems  are  a  popular  education  reform.  We  show  that  uncoordinated  offers  in  NYC’s  school  assignment  mechanism  generated  mismatches.  One-third  of  applicants were unassigned after the main round and later administratively placed at less desirable schools. We evaluate the effects of the new coordinated mechanism based on deferred acceptance using estimated student preferences. The new mechanism achieves 80 per-cent of the possible gains from a no-choice neighborhood extreme to a utilitarian benchmark. Coordinating offers dominates the effects of further algorithm modifications. Students most likely to be previously administratively  assigned  experienced  the  largest  gains  in  welfare  and subsequent achievement."


Here's the ungated working paper

Wednesday, May 16, 2018

"Economics that works" in Bloomberg, celebrates Parag Pathak as a reply to some critics of economics


A Top Econ Prize for a Theory That Works
This economist figured out a better way to assign students to public schools.
By Noah Smith, May 15

Here are the opening lines:

"What do people think economic theorists do? The pundits who regularly criticize the profession, particularly in the pages of British magazines, seem to think that they spend all their time making abstruse, unrealistic theories about how free markets are the best of all possible worlds. And it's true that there are still a few economists out there who are essentially doing that. But a lot of theorists are doing something much more humble and practical work on small-bore theories that can be immediately applied to make the real world a little more efficient.

Parag Pathak is a theorist of this latter type. "

And here are the closing lines (what's in between is well worth reading too:)

"In an age when bashing economics is in vogue, the critics should pay attention to researchers like Pathak. Their theories are not as grandiose as the macroeconomic ideas that appear in the press — but they really work, and every day they improve people’s lives."

Wednesday, February 5, 2020

Market Design at 25, May 14-15 in Washington DC

The NBER is holding a conference in May, in Washington.

"The conference, which has been organized by Irene Lo, Michael Ostrovsky, and Parag Pathak, is timed to roughly commemorate the 25th anniversary of the first FCC spectrum auction, in 1994, the redesign of the National Resident Match Program (begun in 1995, completed in 1998), and the launch of the sulphur dioxide allowance-trading program under Title IV of the Clean Air Act Amendments (amended in 1990, initiated in 1995).  The conference goal is to assess the key contributions of market design in a number of specific fields and policy areas, and to identify key open questions that are priorities for future research."


Market Design @ 25

Authors Please upload your paper and slides here.
Irene Y. Lo, Michael Ostrovsky, and Parag A. Pathak, Organizers
May 14-15, 2020
JW Marriott Hotel, 1331 Pennsylvania Avenue, Washington, DC
Thursday, May 14
8:00 am
Continental Breakfast
8:30 am
Spectrum Auctions
- Opening speaker: Jessica Rosenworcel, FCC Commissioner
- Overview: Paul Milgrom, Stanford University
- Viewpoint: Evan Kwerel, FCC
9:55 am
Break
10:10 am
Matching and Broadening the Definition of Markets
- Overview: Alvin Roth, Stanford University and NBER
- Viewpoint 1: Edward Glaeser, Harvard University and NBER
- Viewpoint 2: Susan Athey, Stanford University and NBER
11:20 am
Break
11:35 am
Market Design for the Environment
- Overview: Michael Greenstone, University of Chicago and NBER
- Viewpoint 1: Richard Schmalensee, Massachusetts Institute of Technology and NBER
- Viewpoint 2: Nathan Keohane, Environmental Defense Fund
12:45 pm
Lunch
2:15 pm
Market Design in Healthcare
- Overview: Amy Finkelstein, Massachusetts Institute of Technology and NBER
- Viewpoint 1: Marc Miller, LJAF / Former MedPac
- Viewpoint 2: Kate Ho, Princeton University and NBER
3:25 pm
Market Design in Transportation
- Overview: Michael Ostrovsky, Stanford University and NBER
- Viewpoint 1: David Shmoys, Cornell University
- Viewpoint 2: TBA
4:35 pm
Break
4:50 pm
Market Design in Developing Countries
- Overview: Kevin Lleyton-Brown, University of British Columbia
- Viewpoint 1: Tavneet Suri, Massachusetts Institute of Technology and NBER
- Viewpoint 2: Jishnu Das, Georgetown University
6:00 pm
Adjourn
6:30 pm
Conference Dinner
Friday, May 15
7:45 am
Continental Breakfast
8:15 am
Market Design for Education
- Overview: Parag Pathak, Massachusetts Institute of Technology and NBER
- Viewpoint 1: Derek Neal, University of Chicago and NBER
- Viewpoint 2: Neerav Kingsland, City Fund
9:25 am
Break
9:40 am
Market Design for Organ Transplantation
- Overview: Tayfun Sonmez, Boston College
- Viewpoint 1: Nikhil Agarwal, Massachusetts Institute of Technology and NBER
- Viewpoint 2: Jennifer Erickson, formerly White House OSTP
10:50 am
Break
11:05 am
Market Design for Public Housing
- Overview: Nathan Hendren, Harvard University and NBER
- Viewpoint 1: Winnie van Dijk, University of Chicago and NBER
- Viewpoint 2: Marge Turner, Urban Institute
12:15 pm
Lunch
1:15 pm
Electricity Market Design
- Overview: Mar Reguant, Northwestern University and NBER
- Viewpoint 1: Bob Wilson, Stanford University
- Viewpoint 2: Shmuel Oren, University of California at Berkeley
2:25 pm
Market Design in Online Markets
- Overview: Preston McAfee, formerly Caltech and Microsoft
- Viewpoint 1: Hal Varian, Google
- Viewpoint 2: Irene Lo, Stanford University
3:35 pm
Break
3:50 pm
Market Design in Financial Markets
- Overview: Darrell Duffie, Stanford University and NBER
- Viewpoint 1: Eric Budish, University of Chicago and NBER
- Viewpoint 2: Gary Gensler, Massachusetts Institute of Technology
5:00 pm
Adjourn

Wednesday, May 27, 2015

Fuhito Kojima and Parag Pathak receive the 2016 Social Choice and Welfare Prize

 Congrats to Fuhito and Parag:)

FUHITO KOJIMA AND PARAG PATHAK RECEIVE THE HEIGHT SOCIAL CHOICE AND WELFARE PRIZE

A jury composed of Claude d'Aspremont (chair, President-elect of the Society for Social Choice and Welfare), Vincent Conitzer, Bhaskar Dutta (President of the Society for Social Choice and Welfare), Marc Fleurbaey and Tim Roughgarden has chosen to award the height Social Choice and Welfare Prize jointly to Fuhito Kojima (Stanford  University) and Parag Pathak(MIT).

The purpose of the Social Choice and Welfare Prize is to honour young scholars of excellent accomplishment in the area of social choice theory and welfare economics. The laureate should be 40 years or less as of January of the year when the International Meeting of the Society for Social Choice and Welfare is scheduled to take place. During this meeting, the prize winner(s) will give a one-hour lecture.

The SCW prize medal "La Pensée" ("The Thought") is due to Raymond Delamarre (1890-1986), a rather well-known French sculptor associated with what has been called "Art Deco" (Chrysler Building and Empire State Building in New York, the architects Mallet-Stevens or Le Corbusier in France). He is in particular famous for his work at the entrance of the Suez Canal. A web site: www.atelier-raymond-delamarre.fr.



PAST LAUREATES :

2014: VINCENT CONITZER and TIM ROUGHGARDEN

2012 : LARS EHLERS and ADAM MEIROWITZ

2010 :  FRANZ DIETRICH and CHRISTIAN LIST

2008 :  TAYFUN SOMNEZ

2006  : JOHN DUGGAN

2004 :  FRANCOIS MANIQUET

2002 : MATTHEW JACKSON

Saturday, July 31, 2021

Tom Payzant, Boston schools superintendent who reformed school choice, dies at 80

 Tom Payzant played a critical role in transforming Boston's school choice from an immediate acceptance algorithm that exposed students and families to complex strategic risk when navigating the system, to a deferred acceptance algorithm that simplified their participation. As Superintendent of Boston Public Schools, Tom came to understand those issues well, and acted on them.

Here's his obit in the Boston Globe.

Thomas Payzant, whose education vision lifted Boston’s schools, dies at 80, By Bryan Marquard

and here's the statement from Boston Public Schools:

SUPERINTENDENT'S STATEMENT ON THE PASSING OF TOM PAYZANT


Here's a pic I took of Atila Abdulkadiroglu, Parag Pathak, and Tayfun Sonmez when we met with Payzant and his colleagues at Boston Public School headquarters, during the years we worked with BPS, starting around 2003.

Atila Abdulkadiroglu, Parag Pathak and Tayfun Sonmez at Boston Public School headquarters

Here's a paper that came out of those meetings, describing the deliberations that ultimately led BPS to adopt a deferred acceptance algorithm design for it's school choice system.


Over the course of those years, I was privileged to watch Parag evolve from a super smart young grad student to being a leader in the design of school choice.

I'll post tomorrow about some of Parag's latest efforts to bring the work associated with the design and evaluation of school choice, and market design more generally, into the world of startup companies and big university labs.

Monday, September 4, 2023

Covid medication: allocation, information, hesitancy, and uptake: what are some things we have learned?

 I've posted before about how informational advertising about vaccine availability and safety seems to have had a positive effect on vaccination rates among disadvantaged populations. There was particular concern in the U.S. at one point that Black people were less likely to receive vaccines and other medications than other Americans.

Today's post collects several papers about the effect of randomly allocating invitations for temporarily scarce Covid medications, while giving members of disadvantaged groups a higher probability of receiving an invitation.  Included will be an editorial warning us that we shouldn't be satisfied to judge the outcome of a market design by its intended outcome ("Moving Beyond Intent and Realizing Health Equity").

There are market design lessons in these last few years of Covid experience that I hope will help make the responses to future pandemics more effective. Not least of these is that the allocation of public health  and medical resources turns out to be quite different from  the allocation of other kinds of resources, in many important ways that reflect the broader economic and social environments in which different kinds of allocation takes place.

###

Here's a paper in the most recent issue of JAMA Health Forum, by a team that includes both medical professionals and market designers.

Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody , by Erin K. McCreary, PharmD1; Utibe R. Essien, MD, MPH2,3; Chung-Chou H. Chang, PhD4,5; Rachel A. Butler, MHA, MPH6; Parag Pathak, PhD7; Tayfun Sönmez, PhD8; M. Utku Ünver, PhD8; Ashley Steiner, BS9; Maddie Chrisman, PT, DPT10; Derek C. Angus, MD, MPH11; Douglas B. White, MD, MAS11, JAMA Health Forum. 2023;4(9):e232774. Sept. 1, doi:10.1001/jamahealthforum.2023.2774 

"Objective  To describe the development and use of a weighted lottery to allocate a scarce supply of tixagevimab with cilgavimab as preexposure prophylaxis to COVID-19 for immunocompromised individuals and examine whether this promoted equitable allocation to disadvantaged populations.

"Design, Setting, and Participants  This quality improvement study analyzed a weighted lottery process from December 8, 2021, to February 23, 2022, that assigned twice the odds of drug allocation of 450 tixagevimab with cilgavimab doses to individuals residing in highly disadvantaged neighborhoods according to the US Area Deprivation Index (ADI) in a 35-hospital system in Pennsylvania, New York, and Maryland. In all, 10 834 individuals were eligible for the lottery. Weighted lottery results were compared with 10 000 simulated unweighted lotteries in the same cohort performed after drug allocation occurred.

"Main Outcomes:  Proportion of individuals from disadvantaged neighborhoods and Black individuals who were allocated and received tixagevimab with cilgavimab.

"Results:  Of the 10 834 eligible individuals, 1800 (16.6%) were from disadvantaged neighborhoods and 767 (7.1%) were Black. Mean (SD) age was 62.9 (18.8) years, and 5471 (50.5%) were women. A higher proportion of individuals from disadvantaged neighborhoods was allocated the drug in the ADI-weighted lottery compared with the unweighted lottery (29.1% vs 16.6%; P < .001). The proportion of Black individuals allocated the drug was greater in the weighted lottery (9.1% vs 7.1%; P < .001). Among the 450 individuals allocated tixagevimab with cilgavimab in the ADI-weighted lottery, similar proportions of individuals from disadvantaged neighborhoods accepted the allocation and received the drug compared with those from other neighborhoods (27.5% vs 27.9%; P = .93). However, Black individuals allocated the drug were less likely to receive it compared with White individuals (3 of 41 [7.3%] vs 118 of 402 [29.4%]; P = .003).

...

"Conclusions and Relevance:  The findings of this quality improvement study suggest an ADI-weighted lottery process to allocate scarce resources is feasible in a large health system and resulted in more drug allocation to and receipt of drug by individuals who reside in disadvantaged neighborhoods. Although the ADI-weighted lottery also resulted in more drug allocation to Black individuals compared with an unweighted process, they were less likely to accept allocation and receive it compared with White individuals. Further strategies are needed to ensure that Black individuals receive scarce medications allocated."

...

"The lottery was repeated over several weeks, but we chose to examine only the first assignment. The interpretation of later rounds is problematic because eventually all individuals were offered tixagevimab with cilgavimab. By focusing on the first draw, we can specifically evaluate whether the intent of the lottery was met."

##############

Closely related reports:

White, D.B., McCreary, E.K., Chang, C.C.H., Schmidhofer, M., Bariola, J.R., Jonassaint, N.N., Persad, G., Truog, R.D., Pathak, P., Sonmez, T. and Unver, M.U., 2022. A multicenter weighted lottery to equitably allocate scarce COVID-19 therapeutics. American Journal of Respiratory and Critical Care Medicine, 206(4), pp.503-506.

Rubin, E., Dryden-Peterson, S.L., Hammond, S.P., Lennes, I., Letourneau, A.R., Pathak, P., Sonmez, T. and Ünver, M.U., 2021. A novel approach to equitable distribution of scarce therapeutics: institutional experience implementing a reserve system for allocation of COVID-19 monoclonal antibodies. Chest, 160(6), pp.2324-2331.*

White, D.B. and Angus, D.C., 2020. A proposed lottery system to allocate scarce COVID-19 medications: promoting fairness and generating knowledge. Jama, 324(4), pp.329-330.

###########

And here's an editorial in the same issue of JAMA Health Forum as the most recent article, pointing out that less-disadvantaged patients among those living in census blocks identified as disadvantaged (in particular  commercially insured and White patients) were much more likely to receive the treatment:

Moving Beyond Intent and Realizing Health Equity, by Atheendar S. Venkataramani, MD, PhD, Invited Commentary, September 1, 2023, JAMA Health Forum. 2023;4(9):e232525. doi:10.1001/jamahealthforum.2023.2525

"In a study published in this issue of JAMA Health Forum, McCreary and colleagues3 report on a landmark effort at the University of Pittsburgh Medical Center (UPMC) to distribute equitably a scarce monoclonal antibody resource, tixagevimab with cilgavimab, for COVID-19 preexposure prophylaxis in immunocompromised individuals. In December 2021, UPMC received an allotment of 450 doses of tixagevimab with cilgavimab from the Pennsylvania Department of Health to cover a large health system with 35 hospitals and 800 outpatient facilities through February 2022. In an ex ante effort to mitigate health disparities and respond to guidance from the Commonwealth of Pennsylvania to allocate scarce resources in a manner that accounts for multiple ethical objectives, UPMC convened an advisory group of clinicians, community stakeholders, and experts in community outreach.

...

"The lottery was constructed using the Area Deprivation Index (ADI) to ensure that patients in highly disadvantaged neighborhoods had an equal opportunity to access tixagevimab with cilgavimab. Patients living in neighborhoods with ADIs above a specific cutoff that has been shown to best target less affluent, rural, and Black patients received 2 entries in the lottery, compared with 1 entry for patients in more advantaged neighborhoods. In their study, McCreary and colleagues3 found that this process resulted in equitable access: similar proportions of individuals in more advantaged and more disadvantaged neighborhoods (about 28% in each group) received tixagevimab with cilgavimab during the study period, although Black patients who were allocated the drug in the lottery were significantly less likely to receive it compared with White patients (7.3% vs 29.4%).

...

"Having identified its patient population, UPMC required only patient addresses as well as publicly available data on ADIs to implement the lottery intervention. The ADIs are defined at the census block group level, which include about 1000 residents on average. Thus, UPMC was able to achieve equitable opportunity to access tixagevimab with cilgavimab across small localities with very different socioeconomic profiles.

...

On the other hand, higher-resolution data that specifically measure the types of intersecting, reinforcing, and cumulative disadvantages faced by historically marginalized groups5 may be needed to achieve equitable outcomes across other dimensions, such as race and ethnicity. Within census blocks, patients assigned the same ADI levels but who may have faced relatively fewer structural barriers compared with Black patients or patients receiving Medicaid—namely, commercially insured and White patients—were more likely to access tixagevimab with cilgavimab conditional on being allocated to receive it in the lottery

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"The lower rates of drug receipt among Black patients also underscores the importance of complementary investments and operational decisions to address additional structural barriers to accessing medical technology.

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"The study by McCreary and colleagues3 represents the type of courageous and rigorous work that is needed to chart a path forward in determining how best to bridge the access gap for leading-edge medical technology. Future work would benefit from the same type of clarity demonstrated in this study by including clear definitions for how equity should be operationalized, attempting to address fragmentation between clinical services and services that address social drivers of health, aligning incentives, and addressing historical barriers that have made it difficult to achieve health equity."

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*Earlier:

Saturday, August 14, 2021