THE BURDEN OF PRENATAL EXPOSURE TO ALCOHOL: REVISED MEASUREMENT OF COST
Main Article Content
Keywords
Alcohol, pregnancy, cost, economic burden, fetal alcohol spectrum disorder
Abstract
Background
In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. Only one study has examined the cost of FASD in Canada. In that study we did not include prospective data for infants under the age of one year, costs for adults beyond 21 years or costs for individuals living in institutions.
Objective
To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level.
Methods
Cross-sectional study design was used. Two-hundred and fifty (250) participants completed the study tool. Participants included caregivers of children, youth and adults, with FASD, from day of birth to 53 years, living in urban and rural communities throughout Canada participated. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs for each in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD.
Results
Total adjusted annual costs associated with FASD at the individual level was $21,642 (95% CI, $19,842; $24,041), compared to $14,342 (95% CI, $12,986; $15,698) in the first study. Severity of the individual's condition, age, and relationship of the individual to the caregiver (biological, adoptive, foster) were significant determinants of costs (p < 0.001). Cost of FASD annually to Canada of those from day of birth to 53 years old, was $5.3 billion (95% CI, $4.12 billion; $6.4 billion).
Conclusions
Study results demonstrated the cost burden of FASD in Canada was profound. Inclusion of infants aged 0 to 1 years, adults beyond the age of 21 years and costs associated with residing in institutions provided a more accurate estimate of the costs of FASD. Implications for practice, policy, and research are discussed.
References
2. Chudley A, Conry J, Cook J, Loock C, Rosales T, LeBlanc N. Public Health Agency of Canada’s National Advisory Committee on Fetal Alcohol Spectrum Disorder. Fetal alcohol spectrum disorder: Canadian guideline for diagnosis. CMAJ 2005;172:S1-S21.
3. Roberts G, Nanson J. Best Practices: fetal alcohol syndrome/fetal alcohol effects and the effects of other substance use during pregnancy. Canada’s Drug Strategy Division. Health Canada, 2000.
4. Riley E, McGee C. Fetal alcohol spectrum disorders: an overview with emphasis on changes in brain and behaviour. Exp Biol Med (Maywood) 2005;230:357-365.
5. Streissguth A, Clarren S, Jones K. Natural history of the Fetal Alcohol Syndrome: A 10 year follow up of eleven patients. Lancet 1985;285-91.
6. Sulik K. Genesis of alcohol-induced craniofacial dysmorphism. Exp Biol Med 2005;230:366-75.
7. American Academy of Pediatrics. (AAP) Fetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorders. Pediatrics 2000;106:358-361.
8. Astley SJ, Clarren SK. Diagnosing the full spectrum of fetal alcohol-exposed individuals: introducing the 4-digit diagnostic code. Alcohol and Alcohol. 2000;35:200-410.
9. Abel E, Sokol R. Incidence of Fetal Alcohol Syndrome and economic impact of FAS-related anomalies. Drug and Alcohol Depend. 1987;19:51-70.
10. Abel E, Sokol R. A revised conservative estimate of the incidence of FAS and its economic impacts. Alcohol Clin Exp Res. 1991;15:514-524.
11. Harwood H, Napolitano D. Economic Implications of the Fetal Alcohol Syndrome/ Alcohol. Health Res World. 1985;38-43.
12. Rice D, Kelman S, Miller L. The economic cost of alcohol abuse. Public Health Rep 1991;106:307-316.
13. Klug MG, Burd L. Fetal alcohol syndrome prevention: annual and cumulative cost savings. Neurotoxicol Teratol 2003 Nov-Dec;25(6):763- 5.
14. Stade B, Ungar W, Stevens B, Beyene J, Koren G. The burden of prenatal exposure to alcohol: measurement of costs. JFAS Int 2006;4:e5 Feb. 2006.
15. Browne G. Psychosocial adjustment of burn survivors. Burns 1985;12-28-35.
16. Statistics Canada. Demographic Statistics CANSIM II. Ottawa. Author, 2008.