High costs of fetal alcohol spectrum disorder

Although the types of cost vary for children versus adults, FASD carries average costs of more than $23,000 per person per year, according to the analysis by Larry Burd, PhD, and colleagues of University of North Dakota School of Medicine and Health Sciences, Grand Fork. An accompanying editorial highlights the need for effective programs to prevent FASD and lessen its lifelong impact on the health and life of affected people worldwide.

Worldwide Economic Impact of FASD

FASD refers to the wide range of lifelong problems caused by exposure to alcohol during pregnancy. Even if a person with FASD does not have congenital malformations sometimes associated with the syndrome, they are at high risk of growth impairments and developmental delays, intellectual disability, and behavioral disorders.

A recent study estimated that 630,000 babies are born around the world each year with FASD- about 1,700 per day. People with FASD are more likely to experience difficulties in school, mental health issues, unemployment, drug and alcohol dependence, homelessness, and troubles with the law. Nearly all cases will never be correctly diagnosed and as a result will never receive treatment appropriate for FASD. This is a major cause of preventable disabilities across the lifespan. "People with FASD often require lifelong and multidimensional services to address their ever-changing and complex needs," Dr. Burd and coauthors write.

To assess the worldwide economic impact of FASD, Dr. Burd and colleagues performed a comprehensive review of studies reporting data on the costs of this condition. The review identified 32 studies, mainly from the United States and Canada. Twenty studies provided data on healthcare costs for people with FASD. Other cost categories included residential care, productivity losses, special education, corrections systems, and "intangible costs."

Total costs per person were estimated about $23,000 per year for children and $24,000 for adults with FASD (in 2017 dollars). There were significant differences in the cost categories: costs for residential care were higher in children, while healthcare costs were higher for adults. Average costs for special education were about $7,200 per year for children and $4,600 for adults.

The data also suggested that FASD leads to substantial costs due to productivity losses -- for example, among caregivers for children with FASD. There was also evidence of high costs to correctional and criminal justice systems due to FASD. Because of the inadequacy of evidence on these cost categories, the researchers believe their cost estimates are likely conservative.

"While hundreds of thousands of children are born every year with this largely preventable condition, many countries devote less than one percent of the cost of caring for people with FASD to its prevention," Dr. Burd and coauthors write. Information on the costs of these services and interventions is critical for developing interventions, prioritizing resources, and funding programs to prevent FASD.

The evidence suggests that the per-person costs of FASD are substantially higher than costs for other common conditions. Estimated costs for children with FASD exceed those for autism ($23,000 versus $17,000), and the costs of FASD in adults are greater than those for diabetes ($24,000 versus $21,000). Acknowledging the limitations of available data, the researchers write, "Future studies should build on high-quality cost methodologies to generate data than can be compared across other [patient] populations."

Writing in an accompanying editorial, Robert J. Sokol, MD, of Wayne State University, Detroit, concurs with the limitations of the data. But he adds that further cost studies "won't solve the problem of the huge number of kids born year in and year out worldwide who will never achieve their full potential because of prenatal alcohol exposure."

"We need to develop effective prevention and mitigation strategies for FASD," Dr. Sokol writes. "That is the appropriate conclusion from this analysis."