Can screening at-risk expectant mothers for a congenital disease actually cost less than not screening them? To find out, senior Chris Carrier and economics Prof. Eileen Stillwaggon examined everything from the price of prenatal testing and treatment to the cost of caring for a child with severe cognitive impairments.
Carrier, an economics major from Lynchburg, Va., conducted research as a Mellon Summer Scholar at Gettysburg College.
"I was interested in exploring not only the economic ramifications of a particular topic, but also the ethical implications," said Carrier of the interdisciplinary focus of his project.
Several conversations about his Mellon project with Stillwaggon, who has extensively examined the economics of disease (notably HIV/AIDS), helped Carrier narrow his research focus.
When one of the world's top experts on congenital toxoplasmosis approached Stillwaggon about conducting a study to examine the costs of screening for the disease, she immediately thought of Carrier's research interests.
Congenital toxoplasmosis, a parasitic infection that can be transferred from mother to fetus, is often asymptomatic in adults, but has potentially devastating effects on a fetus such as severe visual, hearing, and cognitive impairments. However, with early detection and treatment, the effects can be diminished.
Congenital toxoplasmosis was fairly common in France until a nationally mandated detection and treatment program was put into place, greatly reducing the rate and severity of congenital infection. Seeking to repeat the French success in Illinois, a bill was introduced in the State Senate to mandate the offer of monthly screening for expectant mothers.
Before making a decision, the State Senate wanted to examine research, including economic analysis of the costs of screening and the benefits of early intervention.
The aspect of the debate that Carrier and Stillwaggon focused on was the economic viability of screening expectant mothers as opposed to not screening them. Using a method called decision analysis, they examined all of the possible outcomes for screening and not screening, assigned probabilities for every outcome based on clinical findings in the United States and France, and applied cost estimates to each of those outcomes.
While not entirely conclusive, due to the fact that congenital toxoplasmosis is not a nationally reportable disease and because infection rates vary greatly geographically, the results of the study were thought-provoking. Carrier and Stillwaggon found that it is cost-saving from a societal perspective to screen expectant mothers since the price of testing and prenatal treatment amounts to less than costly treatments for children born with severe disabilities due to the disease.
As he finishes his time at the College, Carrier acknowledges that his academic work and research helped shape his future course. He plans on continuing to combine his interest in economics and health issues either in the world of academia or business.
"I really enjoyed learning about the ethical implications and the application of this research. The project may have tangible effects and families may benefit as a result of our research," said Carrier.
The research will continue after Carrier earns his degree. Ultimately, it will be submitted for peer review and Stillwaggon will consult with the CDC to discuss their findings. She also expects to give testimony on the results before the Illinois State Senate this spring.
"Chris really understood the complexity of this issue, and he was marvelous to work with," noted Stillwaggon. "I think his grasp of the subject is evident in his thesis and the results will play a role in public health decisions."
Mellon projects are connected to a student's current course of study, mentored by a faculty member, and conducted the summer before a student's sophomore, junior, or senior year. Preference is given to projects in the humanities, arts, social sciences, Middle Eastern and Islamic Studies, and to those that are interdisciplinary in nature.
Founded in 1832, Gettysburg College is a highly selective four-year residential college of liberal arts and sciences with a strong academic tradition that includes Rhodes Scholars, a Nobel laureate and other distinguished scholars among its alumni. The college enrolls 2,600 undergraduate students and is located on a 200-acre campus adjacent to the Gettysburg National Military Park in Pennsylvania.
Contact: Nikki Rhoads, assistant director of communications, 717.337.6803Posted: Tue, 14 Dec 2010
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