European Journal of Pediatrics

, Volume 170, Issue 11, pp 1391-1400

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Economic burden of neural tube defects and impact of prevention with folic acid: a literature review

  • Yunni YiAffiliated withMapi Values Email author 
  • , Marion LindemannAffiliated withBayer Schering Pharma AG
  • , Antje ColligsAffiliated withBayer Schering Pharma AG
  • , Claire SnowballAffiliated withMapi Values


Neural tube defects (NTDs) are the second most common group of serious birth defects. Although folic acid has been shown to reduce effectively the risk of NTDs and measures have been taken to increase the awareness, knowledge, and consumption of folic acid, the full potential of folic acid to reduce the risk of NTDs has not been realized in most countries. To understand the economic burden of NTDs and the economic impact of preventing NTDs with folic acid, a systematic review was performed on relevant studies. A total of 14 cost of illness studies and 10 economic evaluations on prevention of NTDs with folic acid were identified. Consistent findings were reported across all of the cost of illness studies. The lifetime direct medical cost for patients with NTDs is significant, with the majority of cost being for inpatient care, for treatment at initial diagnosis in childhood, and for comorbidities in adult life. The lifetime indirect cost for patients with spina bifida is even greater due to increased morbidity and premature mortality. Caregiver time costs are also significant. The results from the economic evaluations demonstrate that folic acid fortification in food and preconception folic acid consumption are cost-effective ways to reduce the incidence and prevalence of NTDs. This review highlights the significant cost burden that NTDs pose to healthcare systems, various healthcare payers, and society and concludes that the benefits of prevention of NTDs with folic acid far outweigh the cost. Further intervention with folic acid is justified in countries where the full potential of folic acid to reduce the risk of NTDs has not been realized.


Neural tube defects Spina bifida Economic burden Cost Folic acid Prevention