Day 43 of 99 Days to FASDay: Cost of FASD in Canada

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While these costs are from Canada and are six years old, and they use old prevalence rates – illustrating how difficult it is to do a cost analysis without consistent reporting and recognition across the country – never mind the globe, there was a systematic review of costs in Canada and USA published in 2020. A summary  From Drug and Alcohol Review findings and analysis was prepared but unfortunately I struggle to understand the language in some reports. If anyone can provide results in simple terms, please feel free to comment.

So for this year, we kept the same information obtained from this report.

COSTS OF FETAL ALCOHOL SPECTRUM DISORDER IN THE CANADIAN CRIMINAL JUSTICE SYSTEM by Nguyen Xuan Thanh and Egon Jonsson

School of Public Health, University of Alberta, Edmonton, Canada; Institute of Health Economics Edmonton, Alberta, Canada; University of Alberta and University of Calgary, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada

It was previously estimated that the total cost of FASD for Canada was $6.2 billion in 2009 CA$ (about $6.8 billion in 2014 CA$). Of this, health care accounted for 30%, education 25%, social services 19%, correctional services 14%, and others 13%.

As correctional services are only a part of the CJS, the previous estimate is likely to be underestimated. Based on new costs of the CJS estimated in this study (average: $3.9 billion; range: $1.9 billion to $7.0 billion), we have updated the total cost of FASD in Canada.

Accordingly, the total cost of FASD in Canada is $9.7 billion (range: $7.7 billion to $12.8 billion), of which health care accounts for 21% (range: 16% to 26%), education for 17% (range: 13% to 21%), social services for 13% (range: 10% to 17%), criminal justice for 40% (range: 25% to 55%), and others for 9% (range: 7% to 11%).

This updated total cost of FASD in Canada is comparable to the total cost of FASD estimated through the recent estimated annual health care cost of FASD ($5,600) and the recent health care proportion (21%) of the total cost of FASD.

Specifically, the total cost per person with FASD per year is estimated at $27,000 (5,600*100/21) and the total cost of FASD for Canada will be approximately $9.5 billion (if the previously estimated prevalence of FASD, 1% of population, is used) and $11.3 billion (if the recently estimated prevalence of FASD, 1.2% of population, is used) given the population of Canada is about 35 million.

NOTE: In 2018 the population of Canada was 37 million. CanFASD estimates the prevalence of FASD in Canada at 4% of the general population, so not only due to that and updated costs, we know the cost in 2019 would be higher than $11.3 billion.

There are quite a few reports, with different costs, in different years and different prevalence rates. Here are a few more, including the Review noted above:

2020: FETAL ALCOHOL SPECTRUM DISORDER: A SYSTEMATIC REVIEW OF THE COST OF AND SAVINGS FROM PREVENTION IN THE UNITED STATES AND CANADA

From Drug and Alcohol Review findings and analysis

The literature on the costs of and savings from prevention of Fetal alcohol spectrum disorder (FASD) was reviewed and a model for the US and Canada of projected savings based on the expansion of existing evidence-based prevention models was presented.

Researchers conducted a systematic review of published literature on the cost of FASD prevention and interviewed experts in the field. Evidence-based prevention programs were applied to women at the highest risk to have a future child with fetal alcohol syndrome leading to the reduction in the cost of prevention of one case by $1,215,600 in the US.

This is a 62 fold cost savings compared with the cost of preventing one case among all women who drink. These findings support the expansion of risk-based prevention strategies for fetal alcohol spectrum disorder in the US and Canada as economically efficient and worthwhile for society.

May 2019 Toronto Public Health

In Canada, the direct and indirect costs of FASD for supportive needs in health, mental health, social services, education, and the negative costs through criminality and the criminal justice system are estimated to be $4 billion/year. From a Canadian FASD Research Network. FASD Fact Sheet

The Burden and Economic Impact of Fetal Alcohol Spectrum Disorder in Canada reported $1.8 billion in 2013 by CanFASD. (Previous link not valid).

If you know of a more recent study, for Canada, or have costs for other countries, please leave a comment so we can update this post.

2018:

According to NOFAS (USA): There are very few studies that have estimated the economic cost of FAS and none that have estimated the cost of FASD.

According to a literature study of all of the current available information on the cost of FAS, there have so far been no studies that holistically consider all of the possible costs of FAS. The ten U.S. studies conducted so far do not take important variables into account like the cost of law enforcement, child welfare, research and prevention efforts, mental health services, help with mild physical and learning disabilities, or the lost productivity of both parents/guardians and individuals with FASD.

The most recent study conducted in 1992 and updated to adjust for changes in healthcare costs in 2000 by the Lewin Group for the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates the cost of FAS to be approximately $3.9 billion. However, that number is almost certainly way too low and more data is needed to understand the true cost of FASD, which is likely at least ten times greater than the cost of FAS.

Source: “What Do We Know about the Economic Impact of Alcohol Spectrum Disorder? A Systematic Literature Review” Alcohol and Alcoholism (2011)

Original 2017 Post

Day 43 of 99 days to FASDay

Welcome to Day 43 of 99 Days to 9.9 FASDay – September 9. Today’s information relates directly to Canadian statistics, but it should give people from other countries a basis to examine relative costs for FASD. I was not able to find an international study on costs. If you know of one to a particular country, feel free to leave a comment with a link.

It is important to highlight that the study noted above used the most conservative assumptions, which means that the costs presented are considered the minimal costs associated with FASD in Canadian society.

The following cost drivers were included in this study:

  1. Direct cost of health care (speech-language interventions, prescription drug use, acute inpatient care, psychiatric care, emergency department and day surgery visits, screening and diagnosis, and specialized addiction treatment);
  2. Direct cost of law enforcement (corrections);
  3. Other direct costs (children and youth in care, supportive housing, long-term care, special education, and prevention and research); and
  4. Indirect costs (productivity losses due to disability and premature mortality of individuals with FASD).

Additional costs, noted by the authors, not included, but should be considered in future assessments: the cost of productivity losses of parents/caregivers of people with FASD, and the non-monetary or intangible costs such as pain, suffering, stress and guilt [of mothers].

Finally, the authors state:

These cost figures, as powerful arguments, should not be misused for the further stigmatization of mothers with alcohol dependence. Rather, they should be used as strong scientific evidence demonstrating the burden and cost associated with FASD by policy-makers formulating policies on programs and funding support for the numerous activities required to improve the lives of people with FASD and their families, and to prevent further alcohol-exposed pregnancies.

As this 200 page report was copyrighted, I was only able to use brief quotes. Once again, original links to CanFASD website are no longer valid. The Report is called: The Burden and Economic Impact of Fetal Alcohol Spectrum Disorder in Canada.

Come back tomorrow for Day 44 in our 99 day journey to FASDay.

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