title: Preconception care: preliminary estimates of costs and effects of smoking cessation and folic acid supplementation.
abstract: OBJECTIVE
  To assess costs and effectiveness of preconception counseling for all women planning pregnancy in The Netherlands with regard to folic acid supplementation and smoking cessation counseling.
  
  
  METHODS
  Costs and effects were estimated based on 200,000 women approached yearly and uptake rates of 50% and 75%. Effectiveness and potential savings were based on hospital costs of neural tube defects, low birth weight, very low birth weight and perinatal death attributable to maternal smoking.
  
  
  RESULTS
  Total costs were estimated at dollar 5.1 million and dollar 7.2 million at uptake rates of 50% and 75%, respectively. If 50% of women would seek preconception counseling, 22 neural tube defects, 98 low-birth-weight infants, 10 very-low-birth-weight infants and 7 perinatal deaths could be avoided. At 75% uptake, 33 neural tube defects, 146 low- and 15 very-low-birth-weight infants, and 11 perinatal deaths could be avoided.
  
  
  CONCLUSIONS
  Net costs of preconception counseling amount to dollar 3.7 million and dollar 5.0 million when considering cases prevented and subsequent potential savings in costs of neural tube defects and smoking-related morbidity only. However, in light of many other preventable adverse outcomes and the potential of preconception counseling to prevent significant lifetime costs for affected children, the net costs may ultimately result in a favorable cost-savings balance. Moreover, the importance of a healthy child cannot be expressed in terms of costs and savings alone.
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, The Netherlands.
authors.forename: Sabina
authors.initials: S
authors.lastname: de Weerd
authors.forename: Johan J
authors.initials: JJ
authors.lastname: Polder
authors.forename: Titia E
authors.initials: TE
authors.lastname: Cohen-Overbeek
authors.forename: Luc J I
authors.initials: LJ
authors.lastname: Zimmermann
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
mesh_terms: D000328:Adult; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003376:Counseling; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D009017:Morbidity; D009426:Netherlands; D009436:Neural Tube Defects / Q000191:economics / Q000517:prevention & control; D016742:Preconception Care / Q000191:economics*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016540:Smoking Cessation / Q000191:economics*
chemical_list: D005492:Folic Acid