Abstract
Background: Periconceptional intakes of folic acid (FA) reduce the risk of having a fetus affected anencephaly and spina bifida by 50-70%. The Chilean Ministry of Health mandated fortification of wheat flour at a level of 2.2 mg/FA/kg starting January 2000. This fortification policy served to increase intake of FA by 427 mcg/d that was associated to an overall 43% reduction in the incidence of neural tube defects (NTD) affected pregnancies. An economic evaluation of the program should provide useful information.
Methods: We compared the strategy of fortification with no fortification. Estimation of incremental cost per case averted (C/E ratios) were done extrapolating the incidence risk reduction from program evaluation to the total number of live births and fetal deaths occurring in 2001. C/E ranges were presented for the 95% confidence interval of risk reduction. Economic benefits to the averted costs resulting from preventing births with NTDs (medical and rehabilitation long term cost) in a one-year birth cohort were calculated.
Results: The one year program cost was I$ 447.700.Case averted and cost (expressed in International Dollars (I$) per case averted were:
The cost per DALYs averted without and with 3% discount was 46 (44-67) and 119 (109 -166) I$. The net saving at 3% discount was I$ 5.5 million.
Conclusion: the decision of fortifying the wheat flour with FA has demonstrated significant benefits in health and economical indicators supporting the continuation of this program. Other countries with higher proportion of infant mortality explained by congenital malformation and with existing programs of micronutrients grain fortification may also benefits of FA fortification.
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Llanos, A., Hertrampf, E., Cortes, F. et al. Cost-Effectiveness of a Folic Acid Fortification Program in Chile: TL018. Pediatr Res 60, 636 (2006). https://doi.org/10.1203/00006450-200611000-00028
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DOI: https://doi.org/10.1203/00006450-200611000-00028