Costs and benefits of folic acid fortification in the United States: economic analysis, regulatory action, and public health

ManuscriptThe United States Food and Drug Administration (FDA) required that as of January 1, 1998, manufacturers of enriched cereal- grain products fortify their products with folic acid to reduce the number of pregnancies affected by a neural tube defect (NTD). Prior to adoption of the regulation in 1996, three economic evaluations projected the net economic benefits or cost savings of folic acid fortification. The expected percentage decline in NTDs in these three studies was between 2.6% and 10.5%. Birth defects surveillance data indicate that since fortification there has been a 20% to 30% decline in births with either spina bifida or anencephaly. We estimate that folic acid fortification is associated with an economic benefit of $425 million per year in the United States and constitutes a major public health success that has resulted from regulatory actio

Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation

pre-printObjective: To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived.. Data Source/Study Setting: An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design™, its version of the Patient Centered Medical Home. Study Design: Mixed methods. Data Collection/Extraction Methods: Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semi-structured interviews, focus groups, Centers for Medicare and Medicaid Services database and the Utah All Payers Claims Database. Principal findings: Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Conclusions: Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence

Half-life of cost-of-illness estimates: the case of Spina Bifida

ManuscriptNeural tube defects, which include spina bifida, are one of the most frequent and important categories of birth defects. Accordingly, there has been considerable interest in studying the impact of spina bifida as a public health problem. This impact can be measured in various ways, including disease-specific mortality, morbidity, functional limitation or disability, and quality of life impairment. Each of these measures captures one component of the total burden of disease. Such measures of impact are important because they allow public health agencies, researchers, and health care providers to understand the effects of preventive or diagnostic interventions, changes in disease incidence or prevalence, and new technologies

For cost-reducing technologies, knowing markets is to change them

Journal ArticleSponsored research from a NSF Foundation/Whitaker Foundation initiative on cost-reducing technologies brought together faculty from engineering, medicine, and social sciences to link economic and policy assessments to engineering design. The technology under development is to be an inexpensive, easy-to-use monitor for self-management of metabolic diseases by patients, with specific application to phenylketonuria (PKU). While the technology remains in development, the experience, including discussions with others in the Whitaker and National Science foundations' program, raised interesting issues about economics, policy, and cost-reducing technologies

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

The Half-Life of Cost-of-Illness Estimates: The Case of Spina Bifida

Health, Spina Bifida

Reevaluating the Benefits of Folic Acid Fortification in the United States: Economic Analysis, Regulation, and Public Health

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

The Costs and Benefits of Folic Acid Fortification in the United States: A Comparison of Ex Ante and Ex Post Economic Evaluations

The United States Food and Drug Administration (FDA) required that manufacturers of enriched cereal-grain products as of January 1, 1998 fortify their products with folic acid to reduce the number of pregnancies affected a by neural tube defect (NTD). Prior to adoption of the regulation in 1996, three economic evaluations projected net economic benefits or cost savings from folic acid fortification. The expected decline in NTDs was between 2.6% and 10.5%. Birth defects surveillance data indicate a decline of 20% to 30% in births with spina bifida or anencephaly following fortification. We conservatively estimate that the folic acid fortification results in an economic benefit of $425 million per year in the United States, constituting a major regulatory public health success.Health, Government policy