The Economic Cost of FAS.

Several studies (Abel and Sokol 1987, 1991a,b; Harwood and Napolitano 1985; Rice et al. 1990) have presented estimates of the economic cost to the Nation that results from fetal alcohol syndrome (FAS). Because of differences in the underlying assumptions employed in producing the estimates, the resulting costs cover a wide range. Much of this variation may be attributed to differences in the incidence rates (i.e., the number of FAS cases per 1,000 live births) on which the estimates are based. Further differences reflect discrepancies in the cost components, which are the specific adverse effects of FAS for which costs are computed, that are included in the studies. Estimates of the total economic cost that results from FAS provide a general idea of the dimensions of the problem, but they are of little help in designing or evaluating policies to counter the adverse effects of FAS. Estimates of the lifetime cost associated with a typical FAS case are more useful for such policy-related applications. DIFFERENCES AMONG COST ESTIMATES OF FAS As mentioned above, a key source of differences among estimates of the total cost of FAS is variation in the FAS incidence rates used as the basis for cost calculations. Abel and Sokol(1987) estimated that in 1984, the cost of FAS in the United States was $321 million, based on an average incidence of 1.9 FAS cases per 1,000 live births. This incidence rate was an average drawn from several prospective and retrospective studies. (Prospective studies examined births that occurred while the study was in progress. Retrospective studies analyzed the records of previous births.) In a more recent paper, Abel and Sokol (1991b) produced a much lower cost estimate of $75 million based on an overall incidence rate of 0.33 FAS cases per 1,000 live births. This conservative estimate is derived entirely from prospective studies, which yield lower estimates of FAS incidence than do retrospective studies, in part because there are no prospective data for American Indians and other racial/ethnic groups that may face elevated risks of FAS. Harwood and Napolitano (1985) generated a range of cost estimates using alternative FAS incidence rates of 1.0, 1.67, and 5.0 FAS cases per 1,000 live births. The last rate, which the researchers acknowledged was well above that suggested by the FAS literature, was provided for comparison as an upper boundary that might apply if children born with only some of the defects that constitute FAS were included in the analysis. This range of incidence rates accounted for the wide range of cost estimates reported by Harwood and Napolitano: from $1.95 billion to $9.69 billion. The large discrepancies in the cost estimates obtained in various studies also are due in part to significant differences in the components of cost included in the calculations. All studies include the cost of care for FAS babies with low birth weight; the costs for surgical correction of FAS-related birth defects such as cleft palate, heart defects, and audiological defects; and the cost of care for those with moderate or severe mental retardation due to FAS. In arriving at their original estimate of $321 million, Abel and Sokol (1987) also included the cost of semi-independent supervised support for mildly retarded FAS patients age 21 and under, a cost category that was excluded from their later studies on the grounds that such care was generally required only after age 21 (none of the Abel and Sokol studies included costs beyond age 21). Rice and colleagues (1990) used the same approach and incidence rate as the original Abel and Sokol study but added costs of residential care for patients over 21. These costs account for 80 percent of their total estimate of $1.61 billion for 1985; the remaining 20 percent is accounted for by costs incurred through care of people with FAS-related birth defects and mental retardation. Harwood and Napolitano included estimates of the value of productivity lost as a result of FAS-related mental retardation as well as the cost of treatment and residential care for patients of all ages with FAS. …