Economic evaluation of folic acid food fortification in The Netherlands.
BACKGROUND
Folic acid intake before and during pregnancy reduces neural tube defects (NTD). Therefore, several countries have enriched bulk food with folic acid resulting in a 26-48% decrease in the prevalence of NTDs. In 2000, the Dutch Health Council advised against folic acid enrichment based on literature research; yet formal cost-effectiveness information was absent. We designed our study to estimate cost-effectiveness of folic acid food fortification in the Netherlands.


METHODS
Prevalence of NTD at birth, life-time costs of care, and folic acid fortification costs were estimated using Dutch registrations, Dutch guidelines for costing, (inter)national literature and expert opinions. Both net cost per discounted life year gained and net cost per discounted quality adjusted life year (QALY) gained were estimated for the base case and sensitivity analyses.


RESULTS
In the base case and most sensitivity analyses, folic acid enrichment was estimated to be cost-saving. Bulk food fortification with folic acid remains cost-effective as long as enrichment costs do not exceed euro5.5 million (threshold at euro20 000 per QALY).


CONCLUSIONS
Our model suggests that folic acid fortification of bulk food to prevent cases of NTD in newborns might be a cost-saving intervention in the Netherlands. Additionally, besides the evidence that folic acid reduces the number of NTDs, there are indications that folic acid is associated with the prevention of other birth defects, cardiovascular diseases and cancer. Our model did not yet include these possibly beneficial effects.
Jentink
Janneke
J
Graduate Schools SHARE & GUIDE, Department of Social Pharmacy & Pharmacoepidemiology, University of Groningen, Groningen, The Netherlands.
van de Vrie-Hoekstra
Nienke W
NW
de Jong-van den Berg
Lolkje T W
LT
Postma
Maarten J
MJ
D003362:Cost-Benefit Analysis; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000191:economics; D005527:Food, Fortified / Q000191:economics*; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D009436:Neural Tube Defects / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D039401:Prenatal Nutritional Physiological Phenomena; D015995:Prevalence; D019057:Quality-Adjusted Life Years
D005492:Folic Acid