Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
Appl Health Econ Health Policy. 2019 Apr;17(2):243-254. doi: 10.1007/s40258-018-00454-3.
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.
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.
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.
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.
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.
2009 年，澳大利亚强制在面包制作面粉中添加叶酸，以降低可预防神经管缺陷（NTD）的出生率，如脊柱裂。在该政策出台之前，建模预测每年可减少 14-49 例 NTD。
本研究使用真实世界的数据，首次对澳大利亚强制在面包制作面粉中添加叶酸的成本效益进行了事后评估。
我们开发了一个决策树模型来比较不同的强化策略，并使用登记数据来量化该政策导致的 NTD 发生率的变化。我们采用了一种包括行业和政府成本以及医疗保健和更广泛的社会成本的社会视角。
我们发现，在强制叶酸强化后，每年 NTD 减少 32 例。由于干预成本低，强制叶酸强化改善了健康结果，具有很高的成本效益。该政策在结果上表现出了公平性的改善，特别是在青少年和土著母亲的 NTD 出生率方面。
本研究使用真实的登记数据计算了强制叶酸强化的价值，并证明所获得的收益与预期的模型收益相当。强制叶酸强化（除了包括补充和教育建议的政策）改善了某些人群的公平性，对澳大利亚人口来说是有效且具有高成本效益的。
