Prevented cases of neural tube defects and cost savings after folic acid fortification of flour in Brazil

Abstract

Anencephaly, encephalocele, and spina bifida are congenital neural tube defects and are the main causes of neonatal morbidity and mortality and impose a heavy economic burden on health systems. This study to estimates the direct costs of neural tube defects from the perspective of the Brazilian Ministry of Health, and the prevented cases and cost savings during the period in which mandatory folic acid fortification was in effect in the country (2010–2019). It is a top-down cost-of-illness oriented study based on the prevalence of the disorders in Brazil. Data were collected from the Brazilian Ministry of Health’s outpatient and hospital information system databases. The direct cost was estimated from the total patient-years, allocated by age and type of disorder. Prevented cases and cost savings were determined by the difference in the prevalence of the disorders in the pre- and post-fortification periods based on the total number of births and the sum of outpatient and hospital costs during the period. The total cost of outpatient and hospital services for these disorders totaled R$ 92,530,810.63 (Int$ 40,565,896.81) in 10 years; spina bifida accounted for 84.92% of the total cost. Hospital costs were expressive of all three disorders in the first year of the patient’s life. Between 2010 and 2019, mandatory folic acid fortification prevented 3,499 live births with neural tube defects and resulted in R$ 20,381,586.40 (Int$ 8,935,373.25) in hospital and outpatient cost savings. Flour fortification has proved to be a valuable strategy in preventing pregnancies with neural tube defects. Since its implementation, there has been a 30% decrease in the prevalence of neural tube defects and a 22.81% decrease associated in hospital and outpatient costs.

Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis

“…This high birth prevalence of NTDs in Ethiopia could be explained due to a lag in taking more drastic measures in primary prevention, such as the mandatory fortification of staple food with folic acid. In line with this, there is ample evidence indicating that effective utilisation of mass fortification not only significantly reduces the burden but also the medical treatment costs of NTDs 7 17. Additionally, notable regional variation was observed in the burden of NTDs in Ethiopia.…”

“…16 Globally, various prevention modalities spanning from the advanced genetic test to the simplest micronutrient fortification with folic acid were put forward to avert untoward health consequences of NTDs and circumvent the economic burden imposed on the health system. [17][18][19] Along with the establishment of the surveillance programme, prenatal examination (ie, antenatal ultrasonography, amniocentesis and genetic counselling) is one of the identification platforms that is designed for screening NTD during pregnancy and taking timely measures, including elective termination of the pregnancy. 6 Ultrasound examination, measuring homocysteine concentration and gauging maternal serum alpha-fetoprotein levels are some of the commonly used investigative mechanisms.…”