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Scott D. Grosse, PhD, Norman J. Waitzman, PhD, Patrick S. Romano, MD, MPH and Joseph Mulinare, MD, MPH

Scott Grosse and Joseph Mulinare are with the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Ga. Norman Waitzman is with the Department of Economics, University of Utah, Salt Lake City. Patrick Romano is with the Division of General Medicine and Center for Health Services Research in Primary Care, University of California, Davis, Sacramento.

Correspondence: Requests for reprints should be sent to Scott Grosse, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop E-87, Atlanta, GA 30333 (e-mail: sgrosse{at}cdc.gov).

Before a 1996 US regulation requiring fortification of enriched cereal-grain products with folic acid, 3 economic evaluations projected net economic benefits or cost savings of folic acid fortification resulting from the prevention of pregnancies affected by a neural tube defect. Because the observed decline in neural tube defect rates is greater than was forecast before fortification, the economic gains are correspondingly larger.

Applying both cost–benefit and cost-effectiveness analytic techniques, we estimated that folic acid fortification is associated with annual economic benefit of $312 million to $425 million. The cost savings (net reduction in direct costs) were estimated to be in the range of $88 million to $145 million per year.

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