Cost-effectiveness of a folic acid fortification program in Chile.
OBJECTIVE
Periconceptional intake of folic acid reduces the risk of neural tube defects (NTDs), a frequent birth defect that can cause significant infant mortality and disability. In Chile, fortification of wheat flour with folic acid has resulted in significant reduction in the risk of anencephaly and spina bifida. We investigated the cost-effectiveness implications of this policy.


METHODS
We conducted an ex-post economic analysis of this intervention. Estimates of the effect of fortification in decreasing NTDs and deaths were derived from a prospective evaluation. The costs of fortification and provision of medical care to children with spina bifida in Chile were based on primary data collection.


RESULTS
The intervention costs per NTD case and infant death averted were I$ 1200 and 11,000, respectively. The cost per DALY averted was I$ 89, 0.8% of Chile's GDP per capita. Taking into account averted costs of care, fortification resulted in net cost savings of I$ 2.3 million.


CONCLUSIONS
Fortification of wheat flour with folic acid is a cost-effective intervention in Chile, a middle income country in the post-epidemiological transition. This result supports the continuation of the Chile fortification program and constitutes valuable information for policy makers in other countries to consider.
Llanos
Adolfo
A
Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Chile. adolfo_llanos@pediatrix.com
Hertrampf
Eva
E
Cortes
Fanny
F
Pardo
Andrea
A
Grosse
Scott D
SD
Uauy
Ricardo
R
D000368:Aged; D000757:Anencephaly / Q000453:epidemiology / Q000517:prevention & control; D002677:Chile / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000517:prevention & control; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood / Q000191:economics; D005527:Food, Fortified / Q000191:economics*; D006801:Humans; D015994:Incidence; D008297:Male; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D016135:Spinal Dysraphism / Q000453:epidemiology / Q000517:prevention & control
D005492:Folic Acid