Economic Costs of Fetal Alcohol Spectrum Disorders

1
Economic Costs of Fetal Alcohol Spectrum
Disorders

• byHenrick Harwood

FASD Field Trainers Meeting Orlando,
FloridaDecember 2, 2005
2
Overview

• FAS costs US 4.6 billion in 2004
• About 17 per capita 17,000 per FAS
• US has up to 41,000 alcohol impacted (FASD)
  births/yr. or about 4,100 FAS births
• An FAS birth carries lifetime health/special ed
  costs of 753,000 (258,000 today) although can
  be as high as 3.7 million (1.4 million)
• Including quality of life, FAS prevention may be
  cost effective at up to 516,000 per child
• FAS is among the most costly birth defects
• State FAS cost estimates are presented

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Economic Costs of Alcohol Abuse1

• 184.6 B in 1998 670 per capita 2.1 of GDP
• Medical consequences of FAS 2.9
• Lost earnings due to FAS 1.2
• Specialty alcohol services 7.5
• Medical consequences, other 16.0
• Lost earnings, mortality 36.5
• Lost earnings, morbidity 86.4
• Lost earnings, crime/victims 10.1
• Crashes, fires, justice 24.1

1 Source Harwood, H. Updating Estimates of the
Economic Costs of Alcohol Abuse in the United
States Estimates, Update Methods,and Data.
Report prepared by The Lewin Group for the
National Institute on Alcohol Abuse and
Alcoholism, 2000. Available at http//www.niaaa.ni
h.gov.
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This Effort

• Develop new estimates for FASD
• Update prior estimates by The Lewin Group (1998)
• Cost to the US of FAS in a year
• Review of literature by C. Lupton of NGIT
• Update and extend analyses published in 1986
• Cost of a child born with FAS
• Address cost effectiveness, quality adjusted life
  years and willingness to pay

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General Findings from the Literature

• The majority of the literature focuses solely on
  FAS
• Literature related to FAE is limited
• ARBD and ARND are rarely mentioned
• Cost estimates for treatment services related to
  FAS vary considerably

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Different Types of Economic Studies

• Cost of illness
• Cost effectiveness
• Cost benefits

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Concepts Behind Cost of Illness

• Assess overall burden on the economy in use and
  loss of resources per year
• Consequences (epidemiology)
• Primary and comorbid health, social/justice
  system
• Causality (epidemiology)
• Attribution factors
• Costs (economics)
• Approach to valuation, discounting

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COI Often Called Gee Whiz Numbers

• More readily grasped than a large variety of
  diverse impact estimates a single number
• These numbers can be large
• Attention commanding
• Can be compared to other budgets and problems
• Suggest something SHOULD be done
• Do not tell us WHAT should be done
• Prevention versus treatment or other strategies

9
Components of Economic Costs

• Direct Costs (actual use of goods and services)
• Health system (physical and mental)
• Educational, social, justice systems (not
  transfers)
• Indirect Costs (foregone potential productivity)
• Mortality
• Morbidity/disability
• Incarceration/crime career
• Intangible Costs
• Loss of quality of life, experience of pain and
  suffering
• Not generally included in cost of illness
  estimates

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Prevalence of FASD

• At risk drinking women 18-44 years (past month)
  (CDCs BRFSS)
• Binge (5 drinks/occasion) 13.4
• Heavy (more than 1 drink/day) 5.8
• Binge or heavy 14.9
• FAS prevalence range
• 0.5 to 2.0 cases per 1,000 live births
• FAE believed much more prevalent than FAS
• up to 10 in 1,000 live births for FAS and FAE

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Lifetime Prevalence of Secondary Disabilities for
FAS versus FAE
96
92
68
51
67
51
55
44
54
44
41
28
Streissguth et al. 1996
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Valuation of Indirect Disease Burden

• Deaths
• Morbidity sickness lost days impaired days
• Human capital
• Current market value of productivity
• Present discounted value lost future productivity
• Willingness to pay (up to 6 million/life)
• Quality adjusted life years (QALY) (50-100,000)
• Disability adjusted life years (DALY)
• Years of potential life lost (YPLL)

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Economic Cost of FAS in U.S., in 2004

• National
• Direct 2.66 billion
• Indirect 1.90 billion
• Total 4.56 billion

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Major Direct Cost Components
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Major Direct Cost Components (cont.)
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Direct Costs per Year, per FAS Case
Health Cost/Year
Age
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Lifetime Direct Costs of a Person with FAS

• Direct costs
• Average 753,000
• Maximum 3.7 million
• Discounted Lifetime (3)
• Average 258,000
• Maximum 1.3 million

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Indirect Costs of FAS

• Value of lost potential productivity
• Human capital approach (PHS Guidelines)
• Age/gender adjusted valuation over 60,000/yr
• In 2003 expected 2.5 million at birth
• Discounted 1.1 million
• Mental disability/retardation due to FAS related
  to 20.5 reduction
• 218,500 lifetime discounted loss per child

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Indirect Costs of FAS

• Due to mental disability
• 294,000 persons with FAS
• 73,000 under 18 years 221,000 over 17
• Lost potential productivity worth 1.9 billion in
  2004
• Incidence Prod. Reduction

Severe 2.5 100.0 Moderate 6.0 50.0 Mild 39.0
25.0 Minimal 52.5 10.0 Average 100.0 20.5
20
Source MMWR Dec. 24, 2004/ 53(50) 1178-1181
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State Patterns of At Risk Drinking
At risk means binge or heavy drinking in past
month
22
State Rates of Female At Risk Drinking Females
age 18-44 years, Past Month Binge or Heavy
Drinking
Estimated from 2002 BRFSS U.S. average was
14.9, or 8.4 million females
23
FAS Annual Costs by State, 2004( in millions)
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Are FAS InterventionsWorth Supporting?

• IOM and NIAAA very little strong research
• Havent rigorously evaluated particular
  preventions
• However, can look at potential benefit from
  successful prevention (Harwood and Napolitano,
  1986)
• What will benefits/savings be if save 1 child?

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Cost Effectiveness

• Standard allows comparison across all of health
  (PHS Taskforce Gold et al., 1996)
• Compares medical interventions on the basis of
  cost to save a quality adjusted life year (QALY)
• Medical interventions costing generally considered cost effective

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Quality of Life Preference Scores

• Perfect health 1.0
• Moderate disability .50
• Death/vegetativestate 0.0
• Gen. pop. 35-39 .86
• Gen. pop. 75 years .71
• Congest. heart failure .20
• Legal blindness .48
• Profound deafness .59

• Depression .31
• Schizophrenia .31-.61
• Children withdevelopmental disability
• Severe .40
• Moderate .60
• Mild .80
• Reading disability .77

Harvard Center for Risk Analysis, on-line catalog
of published disease state preference scores
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Impact of FAS on Quality of Life

• Conservative estimate FAS reduces QALY by 17 or
  11 years
• Potential savings from preventing 1 case of FAS
• 550,000 in total value of QALY
• 258,000 in discounted value of QALY
• If an intervention costs less than 516,000 per
  FAS case prevented (discounted indirect plus
  direct costs), it would be considered generally
  cost effective

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Comparison of Birth Defect Costs

• Lifetime costs of a birth with FAS 516,000
• 2 billion for a birth cohort (for 4,000 FAS
  cases)
• A study published by CDC estimated costs of birth
  defects in 1992 at 8 billion (12-15 billion
  now)
• Prematurity costs about 16 billion/year
• Spina bifida and anencephaly 750,000/birth
• Mental retardation cerebral palsy
  900,000/birth
• Vision and hearing defects cost 400-600,000/birth

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Summary

• FAS costs US 4.6 billion in 2004
• An FAS birth carries lifetime direct costs of
  753,000 (258,000 today) although can be as high
  as 3.7 million
• FAS costs/birth similar to other severe birth
  defects
• Costs vary widely by state, based on size and
  rates of female at risk drinking (CA 581 mil.
  WY 9 mil.)
• Costs probably low need better data on FAE,
  mental health, criminal justice
• Even expensive FAS prevention may be cost
  effective up to 516,000 per child