Economic Evaluation of a Neural Tube Defect Recurrence–Prevention Program

• Published in: American journal of preventive medicine 2008-12, Vol.35 (6), p.572-577
• Main Authors: Grosse, Scott D., PhD, Ouyang, Lijing, PhD, Collins, Julianne S., PhD, Green, Denise, MPH, Dean, Jane H., RN, Stevenson, Roger E., MD
• Format: Article
• Language: English
• Subjects: Antenatal care; Cost effectiveness; Cost-Benefit Analysis - economics; Counseling - economics; Female; Folic Acid - administration & dosage; Folic Acid - economics; Folic acid supplement; Food, Fortified - economics; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; Neural Tube Defects - economics; Neural Tube Defects - epidemiology; Neural Tube Defects - prevention & control; Population Surveillance; Pregnancy; Pregnancy Outcome; Prenatal Care - statistics & numerical data; Preventive health care; Quality-Adjusted Life Years; Recurrence; Risk Factors; South Carolina - epidemiology; Vitamin B Complex - administration & dosage; Vitamin B Complex - economics; Women
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2008.07.008

Background Women with a pregnancy affected by a neural tube defect (NTD) are encouraged to take folic acid prior to a subsequent pregnancy, but it is unknown whether organized attempts to identify and counsel such women to prevent recurrent NTDs are cost effective. Methods Data from the South Carolina recurrence–prevention program for October 2001–September 2002 were analyzed between October 2002 and December 2003 to calculate costs. Cost-effectiveness modeling of the program during 1992–2006 was conducted during 2007. Results were calculated for three scenarios based on recurrence risk, supplement use, and the effectiveness of folic acid in preventing recurrences. For each scenario, quality-adjusted life years (QALYs) were calculated separately using prevented NTD-affected live births; prevented NTD-affected births (including fetal deaths); and all prevented NTD-affected pregnancies. Results The prevention program cost approximately $155,000 per year in 2003 dollars to protect 35 pregnancies and prevent approximately one NTD. The direct costs associated with an NTD depend on type and outcome, but are approximately $560,000 in 2003 dollars for a live birth with spina bifida. The base-case cost-effectiveness ratio was $39,600 per QALY gained from avoided NTD-affected live births and stillbirths, and $14,700 per QALY gained from the avoidance of all NTD-affected pregnancies. The baseline NTD recurrence risk and the use of folic acid supplements by women who are at high risk for an NTD-affected pregnancy were influential parameters. Conclusions The South Carolina NTD recurrence–prevention program appears comparable in cost effectiveness to other preventive services. Other states might consider including NTD recurrence prevention in birth defect–prevention programs.