Retrospective Assessment of Cost Savings From Prevention: Folic Acid Fortification and Spina Bifida in the U.S
- PMID:26790341
- PMCID: PMC4841731
- DOI: 10.1016/j.amepre.2015.10.012
Retrospective Assessment of Cost Savings From Prevention: Folic Acid Fortification and Spina Bifida in the U.S
Abstract
Introduction: Although fortification of food with folic acid has been calculated to be cost saving in the U.S., updated estimates are needed. This analysis calculates new estimates from the societal perspective of net cost savings per year associated with mandatory folic acid fortification of enriched cereal grain products in the U.S. that was implemented during 1997-1998.
Methods: Estimates of annual numbers of live-born spina bifida cases in 1995-1996 relative to 1999-2011 based on birth defects surveillance data were combined during 2015 with published estimates of the present value of lifetime direct costs updated in 2014 U.S. dollars for a live-born infant with spina bifida to estimate avoided direct costs and net cost savings.
Results: The fortification mandate is estimated to have reduced the annual number of U.S. live-born spina bifida cases by 767, with a lower-bound estimate of 614. The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791,900, or $577,000 excluding caregiving costs. Using a best estimate of numbers of avoided live-born spina bifida cases, fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million more than the cost of fortification. A lower-bound estimate of cost savings using conservative assumptions, including the upper-bound estimate of fortification cost, is $299 million.
Conclusions: The estimates of cost savings are larger than previously reported, even using conservative assumptions. The analysis can also inform assessments of folic acid fortification in other countries.
Published by Elsevier Inc.
Similar articles
- Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis.Atta CA, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, Rajapakse T, Kaplan GG, Metcalfe A.Atta CA, et al.Am J Public Health. 2016 Jan;106(1):e24-34. doi: 10.2105/AJPH.2015.302902. Epub 2015 Nov 12.Am J Public Health. 2016.PMID:26562127Free PMC article.Review.
- Preventable spina bifida and anencephaly in Europe.Obeid R, Pietrzik K, Oakley GP Jr, Kancherla V, Holzgreve W, Wieser S.Obeid R, et al.Birth Defects Res A Clin Mol Teratol. 2015 Sep;103(9):763-71. doi: 10.1002/bdra.23400. Epub 2015 Jul 14.Birth Defects Res A Clin Mol Teratol. 2015.PMID:26178749
- Countries with an immediate potential for primary prevention of spina bifida and anencephaly: Mandatory fortification of wheat flour with folic acid.Kancherla V.Kancherla V.Birth Defects Res. 2018 Jul 3;110(11):956-965. doi: 10.1002/bdr2.1222. Epub 2018 Mar 13.Birth Defects Res. 2018.PMID:29532629
- Spina bifida before and after folic acid fortification in Canada.De Wals P, Tairou F, Van Allen MI, Lowry RB, Evans JA, Van den Hof MC, Crowley M, Uh SH, Zimmer P, Sibbald B, Fernandez B, Lee NS, Niyonsenga T.De Wals P, et al.Birth Defects Res A Clin Mol Teratol. 2008 Sep;82(9):622-6. doi: 10.1002/bdra.20485.Birth Defects Res A Clin Mol Teratol. 2008.PMID:18655127
- Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification.Kagawa Y, Hiraoka M, Kageyama M, Kontai Y, Yurimoto M, Nishijima C, Sakamoto K.Kagawa Y, et al.Congenit Anom (Kyoto). 2017 Sep;57(5):157-165. doi: 10.1111/cga.12215. Epub 2017 Apr 4.Congenit Anom (Kyoto). 2017.PMID:28185308Free PMC article.Review.
Cited by
- Folic Acid and the Prevention of Birth Defects: 30 Years of Opportunity and Controversies.Crider KS, Qi YP, Yeung LF, Mai CT, Head Zauche L, Wang A, Daniels K, Williams JL.Crider KS, et al.Annu Rev Nutr. 2022 Aug 22;42:423-452. doi: 10.1146/annurev-nutr-043020-091647.Annu Rev Nutr. 2022.PMID:35995050Free PMC article.Review.
- Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis.Ssentongo P, Heilbrunn ES, Ssentongo AE, Ssenyonga LVN, Lekoubou A.Ssentongo P, et al.BMC Neurol. 2022 Jun 1;22(1):202. doi: 10.1186/s12883-022-02697-z.BMC Neurol. 2022.PMID:35650541Free PMC article.
- Quantifying Family Spillover Effects in Economic Evaluations: Measurement and Valuation of Informal Care Time.Grosse SD, Pike J, Soelaeman R, Tilford JM.Grosse SD, et al.Pharmacoeconomics. 2019 Apr;37(4):461-473. doi: 10.1007/s40273-019-00782-9.Pharmacoeconomics. 2019.PMID:30953263Free PMC article.Review.
- Estimating the serum folate concentration that corresponds to the red blood cell folate concentration threshold associated with optimal neural tube defects prevention: A population-based biomarker survey in Southern India.Fothergill A, Crider KS, Rose CE, Bose B, Guetterman HM, Johnson CB, Jabbar S, Zhang M, Pfeiffer CM, Qi YP, Williams JL, Kuriyan R, Bonam W, Finkelstein JL.Fothergill A, et al.Am J Clin Nutr. 2023 May;117(5):985-997. doi: 10.1016/j.ajcnut.2023.01.016. Epub 2023 Apr 19.Am J Clin Nutr. 2023.PMID:37137617Free PMC article.
- Data Needs for Economic Evaluations of Screening in Pediatric Primary Care: A Research Framework.Grosse SD, Kemper AR, Prosser LA.Grosse SD, et al.Pediatrics. 2021 Jul;148(Suppl 1):s45-s50. doi: 10.1542/peds.2021-050693J.Pediatrics. 2021.PMID:34210848Free PMC article.Review.No abstract available.
References
- Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992;327(26):1832–1835.http://dx.doi.org/10.1056/NEJM199212243272602. - DOI - PubMed
- MRC Vitamin Study Research Group Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991;338(8760):131–137.http://dx.doi.org/10.1016/0140-6736(91)90133-A. - DOI - PubMed
- U.S. Food and Drug Administration Food standards: amendments of standards of identity for enriched grain products to require addition of folic acid. Federal Register. 1996;61:8781–8797.
- CDC CDC Grand Rounds: additional opportunities to prevent neural tube defects with folic acid fortification. MMWR Morb Mortal Wkly Rep. 2010;59(31):980–984. - PubMed
- Glasgow RE, Steiner JF. Comparative effectiveness research to accelerate translation: Recommendations for an emerging field of science. In: Brownson RC, Colditz GA, Proctor EK, editors. Dissemination and Implementation Research in Health. Oxford University Press; New York, NY: 2012. pp. 72–92.http://dx.doi.org/10.1093/acprof:oso/9780199751877.003.0004. - DOI
Publication types
MeSH terms
Substances
Related information
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical