The Social Burden of Folic Acid Deficiencies in Switzerland
Simon Wieser *
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
Rafael Plessow
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
*Author to whom correspondence should be addressed.
Abstract
Objectives: The association between folic acid deficiency (FAD) at conception and severe neural tube defects (NTDs) at birth is well documented. We estimate the social costs of NTDs due to FAD in Switzerland considering direct medical and non-medical costs, lost productivity and quality and number of life years lost.
Methods: We build a life-time cost-of-illness model of NTDs due to FAD. Information on prevalence of NTDs, mortality, treatment costs, non-medical support and lost productivity is extracted from disability insurance and hospital registry data and collected in interviews with clinical experts. Attribution of NTDs to FAD and increased mortality rates is based on literature review. Future costs are discounted at 2%.
Results: Prevalence is estimated at 0.30 NTDs per 1000 live births. Prevalence has decreased by half since the 1990s, mainly due to progress in prenatal diagnosis of NTDs leading to termination of pregnancies. High mortality reduces the average life expectancy of children born with a NTD to 44 years. In 2011 yearly average direct medical costs per newborn amounted to USD 18'500 and discounted life-time direct medical costs per newborn to USD 464,000. Total medical costs of NTDs attributable to FAD amounted to USD 10.2 million and total production losses to USD 28.9 million in 2011.
Conclusions: The burden of NTDs in terms of direct costs, production losses and loss of quality adjusted life years is still considerable in Switzerland. A substantial share of this burden could be reduced with policies able to reduce FAD in women in reproductive age.