Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia.
J Nutr. 2013 Jan;143(1):59-66. doi: 10.3945/jn.112.166694. Epub 2012 Dec 5.
The Australian government recently introduced mandatory folic acid fortification of bread to reduce the incidence of neural tube defects (NTDs). The economic evaluation of this policy contained a number of limitations. This study aimed to address the limitations and to reconsider the findings. Cost-effectiveness analysis was used to assess the cost and benefits of mandatory versus voluntary folic acid fortification. Outcomes measures were quality-adjusted life-years (QALYs), life-years gained (LYG), avoided NTD cases, and additional severe neuropathy cases. Costs considered included industry costs and regulatory costs to the government. It was estimated that mandatory fortification would prevent 31 NTDs, whereas an additional 14 cases of severe neuropathy would be incurred. Overall, 539 LYG and 503 QALYs would be gained per year of mandatory compared with voluntary fortification. Mandatory fortification was cost-effective at A$10,723 per LYG and at A$11,485 per QALY. Probabilistic sensitivity analysis showed that at A$60,000 and A$151,000 per QALY, the probability that mandatory fortification was the most cost-effective strategy was 79% and 85%, respectively. Threshold analysis of loss of consumer choice indicated that with a compensation value above A$1.21 [assuming a willingness to pay (WTP) threshold of A$60,000 per QALY] or A$3.19 (assuming a WTP threshold of A$151,000 per statistical life-year) per capita per year mandatory fortification would not be cost-effective. Mandatory fortification was found to be cost-effective; however, inclusion of the loss of consumer choice can change this result. Even with mandatory fortification, mean folate intake will remain below the recommended NTD preventive level.
澳大利亚政府最近推出了强制性叶酸强化面包的政策，以降低神经管缺陷（NTD）的发病率。该政策的经济评估存在一些局限性。本研究旨在解决这些局限性，并重新考虑研究结果。使用成本效益分析来评估强制性与自愿性叶酸强化的成本和效益。结果测量指标是质量调整生命年（QALY）、获得的生命年（LYG）、避免的 NTD 病例和额外的严重神经病变病例。考虑的成本包括行业成本和政府的监管成本。据估计，强制性强化将预防 31 例 NTD，而会增加 14 例严重神经病变病例。与自愿强化相比，每年强制性强化可获得 539 个 LYG 和 503 个 QALY。强制性强化在 A$10,723 每 LYG 和 A$11,485 每 QALY 时具有成本效益。概率敏感性分析表明，在 A$60,000 和 A$151,000 每 QALY 时，强制性强化是最具成本效益的策略的概率分别为 79%和 85%。消费者选择损失的阈值分析表明，在补偿价值高于 A$1.21[假设每 QALY 的支付意愿（WTP）阈值为 A$60,000]或 A$3.19（假设每统计生命年的 WTP 阈值为 A$151,000）时，强制性强化将不再具有成本效益。研究发现强制性强化是具有成本效益的；然而，消费者选择损失的纳入可能会改变这一结果。即使实施了强制性强化，平均叶酸摄入量仍将低于预防 NTD 的建议水平。
