title: Cost-effectiveness of mandatory folate fortification v. other options for the prevention of neural tube defects: results from Australia and New Zealand.
abstract: OBJECTIVE
  To provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).
  
  
  METHODS
  Standard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.
  
  
  RESULTS
  Population-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12,500 per disability-adjusted life year (DALY) averted ($US 9893, pound 5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138,500 per DALY ($US 109 609, pound 56,216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.
  
  
  CONCLUSIONS
  Several options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.
authors.affiliation: Health Economics, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Kim.Dalziel@unisa.edu.au
authors.forename: Kim
authors.initials: K
authors.lastname: Dalziel
authors.forename: Leonie
authors.initials: L
authors.lastname: Segal
authors.forename: Rachelle
authors.initials: R
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000191:economics*; D019587:Dietary Supplements / Q000191:economics; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000191:economics*; D005500:Follow-Up Studies; D005527:Food, Fortified / Q000191:economics*; D006291:Health Policy; D006801:Humans; D009436:Neural Tube Defects / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D014803:Vitamin B Complex / Q000191:economics*; D055815:Young Adult
chemical_list: D014803:Vitamin B Complex; D005492:Folic Acid