Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia

Saing, S; Haywood, P; van der Linden, N; Manipis, K; Meshcheriakova, E; Goodall, S

Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia

Saing, S

Haywood, P

van der Linden, N Manipis, K Meshcheriakova, E

Goodall, S

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Publication Type:: Journal Article
Citation:: Applied Health Economics and Health Policy, 2019, 17 (2), pp. 243 - 254
Issue Date:: 2019-04-10

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Field	Value	Language
dc.contributor.author	Saing, S https://orcid.org/0000-0001-5913-9654	en_US
dc.contributor.author	Haywood, P https://orcid.org/0000-0001-5031-8648	en_US
dc.contributor.author	van der Linden, N	en_US
dc.contributor.author	Manipis, K	en_US
dc.contributor.author	Meshcheriakova, E https://orcid.org/0000-0003-4411-204X	en_US
dc.contributor.author	Goodall, S https://orcid.org/0000-0001-6611-6565	en_US
dc.date.issued	2019-04-10	en_US
dc.identifier.citation	Applied Health Economics and Health Policy, 2019, 17 (2), pp. 243 - 254	en_US
dc.identifier.issn	1175-5652	en_US
dc.identifier.uri	http://hdl.handle.net/10453/132890
dc.description.abstract	© 2019, Springer Nature Switzerland AG. Background: In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14–49 NTDs each year. Objective: Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. Methods: We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. Results: We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. Conclusions: This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.	en_US
dc.relation.ispartof	Applied Health Economics and Health Policy	en_US
dc.relation.isbasedon	10.1007/s40258-018-00454-3	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.title	Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	17	en_US
utslib.for	1402 Applied Economics	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1505 Marketing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	17	en_US

Abstract:

© 2019, Springer Nature Switzerland AG. Background: In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14–49 NTDs each year. Objective: Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. Methods: We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. Results: We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. Conclusions: This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.

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http://hdl.handle.net/10453/132890