The Social Burden of Folic Acid Deficiencies in Switzerland.

Objectives: The association between folic acid deficiency (FAD) at conception and severe neural tube defects (NTDs) at birth is well documented. We estimate the social costs of NTDs due to FAD in Switzerland considering direct medical and non-medical costs, lost productivity and quality and number of life years lost. Methods: We build a life-time cost-of-illness model of NTDs due to FAD. Information on prevalence of NTDs, mortality, treatment costs, non-medical support and lost productivity is extracted from disability insurance and hospital registry data and collected in interviews with clinical experts. Attribution of NTDs to FAD and increased mortality rates is based on literature review. Future costs are discounted at 2%. Results: Prevalence is estimated at 0.30 NTDs per 1000 live births. Prevalence has decreased by half since the 1990s, mainly due to progress in prenatal diagnosis of NTDs leading to termination of pregnancies. High mortality reduces the average life expectancy of children born with a NTD to 44 years. In 2011 yearly average direct medical costs per newborn amounted to USD 18'500 and discounted life-time direct medical costs per newborn to USD 464,000. Total medical costs of NTDs attributable to FAD amounted to USD 10.2 million and total production losses to USD 28.9 million in 2011. Conclusions: The burden of NTDs in terms of direct costs, production losses and loss of quality adjusted life years is still considerable in Switzerland. A substantial share of this burden could be reduced with policies able to reduce FAD in women in reproductive age.

Cost-Effectiveness of Price Reductions in Fortified Powdered Milk for the Reduction of Micronutrient Deficiencies in 6-23 Month Old Children in the Philippines.

Objectives: To estimate the effectiveness and cost-effectiveness of price-based interventions with commercially distributed packaged fortified powdered milk (FPM) for the reduction of iron and vitamin A deficiencies in 6-23 months old Filipino children. Methods: We carried out a survey stratified by socio-economic status among 1600 households and performed a hypothetical marketing experiment to estimate the price elasticity of the demand for FPM. These results were then combined with a systematic review on the efficacy of food fortification in controlled trials and with a model of the lifetime cost-consequences of micronutrient deficiencies (MNDs) in infancy. Results: While a high proportion of children living in wealthier households consume substantial amounts of FPM, consumption is much lower in poorer households. Demand for FPM is considerably more elastic in poor households (price elasticity of -0.8 in lowest versus -0.3 in the highest socio-economic decile). A relative 20% reduction in disability adjusted life years (DALYs) lost can be achieved by discounting prices by 30% among the poorest 20% of the population. This intervention has a cost-effectiveness ratio of 329 USD per DALY gained. Conclusions: Interventions with commercially distributed FPM have the potential to efficiently reduce the burden of MNDs in the Philippines. Interventions targeting poor households are more cost-effective because of the higher prevalence of MNDs, lower levels of current consumption and higher price elasticity of demand. These results may have important implications for the design and implementation of complementary feeding interventions aimed to reduce MNDs.

Burden of Micronutrient Deficiencies by Socio-economic Strata in Children aged 6 Months to 5 years in the Philippines.

Objectives: Micronutrient deficiencies (MNDs) have severe health consequences and are particularly harmful during early childhood. We estimate the burden of iron deficiency (IDA), vitamin A deficiency (VAD) and zinc deficiency (ZnD) in 2 age groups (6-23 and 24-59 months) of Filipino children by socio-economic strata in 2008. Methods: We build a health economic model simulating the consequences of MNDs in childhood over the entire lifetime. The model is based on a health survey and a nutrition survey carried out in 2008. Direct medical costs, production losses and intangible costs are computed and long term costs are discounted to present value. Results: Total lifetime costs of IDA, VAD and ZnD amounted to direct medical costs of 30 million dollars, production losses of 618 million dollars and intangible costs of 122,138 disability adjusted life years (DALYs). Direct medical costs are dominated by costs due to ZnD (89% of total), production losses by losses in future lifetime (90% of total) and intangible costs by premature death (47% of total DALY losses) and losses in future lifetime (43%). Costs of MNDs differ considerably between socio-economic strata (SES) as costs in the poorest third of the households are 5 times higher than in the wealthiest third. Conclusions: MNDs lead to substantial costs in 6-59-month-old children in the Philippines. Costs are highly concentrated in the lower SES and in children 6-23 months old. These results may have important implications for the design, evaluation and choice of the most effective and cost-effective policies aimed at the reduction of MNDs.