Economic evaluation of a neural tube defect recurrence-prevention program.
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.
National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia 30333, USA. sgrosse@cdc.gov
Scott D
SD
Grosse
Lijing
L
Ouyang
Julianne S
JS
Collins
Denise
D
Green
Jane H
JH
Dean
Roger E
RE
Stevenson
D003362:Cost-Benefit Analysis / Q000191:economics*; D003376:Counseling / Q000191:economics*; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000191:economics; D005527:Food, Fortified / Q000191:economics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009436:Neural Tube Defects / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000706:statistics & numerical data*; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000191:economics
D014803:Vitamin B Complex; D005492:Folic Acid