Retrospective Assessment of Cost Savings From Prevention

Grosse, Scott D.; Berry, R. J.; Tilford, John M.; Kucik, James E.; Waitzman, Norman J.

doi:10.1016/j.amepre.2015.10.012

Cited by 103 publications

(49 citation statements)

References 54 publications

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“…Finally, the financial burden associated with caring for an infant born with a neural tube defect, such as spina bifida, can be very high. A recent publication estimated the average lifetime direct cost of caring for an infant with spina bifida to be $791,000 (Grosse et al, 2016). Averting these costs can reduce the significant financial impact of these birth defects on families, the overall economy, and society.…”

Section: Resultsmentioning

confidence: 99%

Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities

Flores

Cordero

Dunn

et al. 2018

Preventive Medicine

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Although strides have been made in preventing neural tube defects (NTDs), Hispanic women remain more likely to have a baby born with an NTD and less likely to know the benefits of, or consume, folic acid than women of other race/ethnic groups. In 1998, the U.S. Food and Drug Administration (FDA) mandated that all enriched cereal grain products be fortified with folic acid; however, corn masa flour (CMF), used to make many corn products that are a diet staple of many Hispanic groups, was not included under this regulation. In 2006, a Working Group began a collaboration to address this disparity by pursuing a petition to FDA to allow folic acid to be added voluntarily to CMF. The petition process was a monumental effort that required collaboration and commitment by partners representing the affected population, manufacturers, scientists, and others. The petition was approved in 2016 and folic acid is now added to CMF products, with expected results of more women achieving the recommended daily folic acid intake, more infants born per year without an NTD, and millions of dollars in direct medical expenditures averted. This 10-year public-private partnership brought together diverse groups that traditionally have different goals. The Working Group continues to work toward ensuring that fortified CMF products are available to the consumer, with the end goal of achieving a reduction in NTD-affected pregnancies.

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Section: Resultsmentioning

confidence: 99%

Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities

Flores

Cordero

Dunn

et al. 2018

Preventive Medicine

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“…The exact human test using 13 C‐ and 2 H double labeled folate fortified cereals established this fortification level (Pfeiffer et al 1997). This fortification mandate is estimated to have reduced the annual number of US live‐birth spina bifida cases by 767 (Grosse et al 2016). The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791 900, excluding caregiving costs.…”

Section: Medical Cost Savings Resulting From Folic Acid Fortificationmentioning

confidence: 99%

“…The present value of mean direct lifetime cost per infant with spina bifida is estimated to be $791 900, excluding caregiving costs. Folic acid fortification is estimated to reduce the present value of total direct costs for each year's birth cohort by $603 million above the cost of fortification (Grosse et al 2016). These estimates of cost savings are larger than those previously reported, even using conservative assumptions.…”

Section: Medical Cost Savings Resulting From Folic Acid Fortificationmentioning

confidence: 99%

“…Megaloblastic anemia (Chanarin 1987) and NTDs (Grosse et al 2016) are well‐known conditions caused by inadequate folate intake, but folate is implicated in many other diseases. For example, moderate hyperhomocysteinemia induced by low folate status is an independent risk factor for cardiovascular disease (CVD) (Ishihara et al 2008; Bentley et al 2009), stroke (Yang et al 2006; Huo et al 2015; Li et al 2016b), colon cancer (Bentley et al 2009), dementia (Jernerén et al 2015), fracture (Gjesdal et al 2007), kidney diseases (Massy 2003) and depression (Bottiglieri 2005; Hiraoka et al 2014).…”

Section: Diseases Prevented By Folic Acid Fortificationmentioning

confidence: 99%

“…Thus, mandatory folic acid fortification of cereal products has been implemented in 82 countries. Mandatory fortification has led to medical cost savings due to the prevention not only of NTDs (Grosse et al 2016), but also of many other diseases described in the next section (Bentley et al 2009). …”

Section: Introductionmentioning

confidence: 99%

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Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification

Kagawa

Hiraoka

Kageyama

et al. 2017

Congenital Anomalies

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The introduction of mandatory fortification of grains with folate in 1998 in the United States resulted in 767 fewer spina bifida cases annually and a cost saving of $603 million per year. However, far more significant medical cost savings result from preventing common diseases, including myocardial infarction, stroke, dementia and osteoporosis. A cost‐effectiveness analysis showed a gain of 266 649 quality‐adjusted life‐years and $3.6 billion saved annually, mainly due to the reduction of cardiac infarction. The recommended folate intake in Japan is 240 μg/day whereas it is 400 μg/day internationally. Our Sakado Folate Project targeted individuals with genetic polymorphism of methylenetetrahydrofolate reductase or with hyperhomocysteinemia. Using, for example, folate‐fortified rice, resulted in an increase in serum folate and a decrease in serum homocysteine in the participants, and reduced medical costs were achieved by decreasing myocardial infarction, stroke, dementia and fracture. Due to the small population of Sakado City (approximately 101 000) and small number of births (693) in 2015, a decrease in spina bifida could not be confirmed but there was a significant decrease in the number of very low birthweight infants. The genome notification of subjects was effective in motivating intake of folate, but the increase in serum folate (from 17.4 to 22.5 nmol/L, 129%) was less than that observed following compulsory folic acid fortification of cereals in the USA (from 12.1 to 30.2 nmol/L, 149.6%). Mandatory folic acid fortification is cheap in decreasing medical costs and is thus recommended in Japan.

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Estimating the Number of Pregnant Women Infected With Zika Virus and Expected Infants With Microcephaly Following the Zika Virus Outbreak in Puerto Rico, 2016

et al. 2016

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IMPORTANCE Zika virus (ZIKV) infection during pregnancy is a cause of congenital microcephaly and severe fetal brain defects, and it has been associated with other adverse pregnancy and birth outcomes.OBJECTIVE To estimate the number of pregnant women infected with ZIKV in Puerto Rico and the number of associated congenital microcephaly cases. DESIGN, SETTING, AND PARTICIPANTSWe conducted a modeling study from April to July 2016. Using parameters derived from published reports, outcomes were modeled probabilistically using Monte Carlo simulation. We used uncertainty distributions to reflect the limited information available for parameter values. Given the high level of uncertainty in model parameters, interquartile ranges (IQRs) are presented as primary results. Outcomes were modeled for pregnant women in Puerto Rico, which currently has more confirmed ZIKV cases than any other US location.EXPOSURE Zika virus infection in pregnant women. MAIN OUTCOMES AND MEASURESNumber of pregnant women infected with ZIKV and number of congenital microcephaly cases. RESULTSWe estimated an IQR of 5900 to 10 300 pregnant women (median, 7800) might be infected during the initial ZIKV outbreak in Puerto Rico. Of these, an IQR of 100 to 270 infants (median, 180) may be born with microcephaly due to congenital ZIKV infection from mid-2016 to mid-2017. In the absence of a ZIKV outbreak, an IQR of 9 to 16 cases (median, 12) of congenital microcephaly are expected in Puerto Rico per year. CONCLUSIONS AND RELEVANCEThe estimate of 5900 to 10 300 pregnant women that might be infected with ZIKV provides an estimate for the number of infants that could potentially have ZIKV-associated adverse outcomes. Including baseline cases of microcephaly, we estimated that an IQR of 110 to 290 total cases of congenital microcephaly, mostly attributable to ZIKV infection, could occur from mid-2016 to mid-2017 in the absence of effective interventions. The primary limitation in this analysis is uncertainty in model parameters. Multivariate sensitivity analyses indicated that the cumulative incidence of ZIKV infection and risk of microcephaly given maternal infection in the first trimester were the primary drivers of both magnitude and uncertainty in the estimated number of microcephaly cases. Increased information on these parameters would lead to more precise estimates. Nonetheless, the results underscore the need for urgent actions being undertaken in Puerto Rico to prevent congenital ZIKV infection and prepare for affected infants.

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Retrospective Assessment of Cost Savings From Prevention

Cited by 103 publications

References 54 publications

Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities

Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities

Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification

Estimating the Number of Pregnant Women Infected With Zika Virus and Expected Infants With Microcephaly Following the Zika Virus Outbreak in Puerto Rico, 2016

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