Cost-effectiveness in FASD prevention. Egon Jonsson, Institute of Health Economics, Edmonton, Alberta, Canada

Transcription

1 Cost-effectiveness in FASD prevention Egon Jonsson, Institute of Health Economics, Edmonton, Alberta, Canada

2 ELLESMERE ISLAND Beauton Sea BANKS ISLAND MELVILLE ISLAND SOMERSET ISLAND DEVON ISLAND Baffin Bay Canada VICTORIA ISLAND PRINCE OF WALES ISLAND Davis Strait Population 33 million YUKON Whitehorse NORTHWEST TERRITORY Great Slave Lake Great Bear Lake Yellowknife NUNAVUT SOUTHHAMPTON ISLAND PRINCE CHARLES ISLAND BAFFIN ISLAND Iqaluit Labrador Sea Lake Athabasca Hudson Bay NEWFOUNDLAND NEWFOUNDLAND St. John's Pacific Ocean VANCOUVER ISLAND BRITISH COLUMBIA Victoria ALBERTA Edmonton SASKATCHEWAN Regina MANITOBA Lake Winnipegosis Lake Winnipeg Lake Nipigon ONTARIO James Bay QUEBEC Quebec NEW BRUNSWICK Fredericton Gulf of St. Lawrence Prince Edward Island Halifax NOVA SCOTIA Winnipeg Lake Superior Lake Huron Toronto Ottawa Lake Ontario Lake Michigan Lake Erie

3 Alberta France Area 660,000 Sq km 675,000 Sq km Population 3.5 million 65.5 Million

4 Everything we do for FASD is prevention

5 Cost-effectiveness of FASD prevention Requires data about costs and benefits Many benefits are intangible and cannot be calculated in economic terms, for example: Caring about someone Understanding needs Providing support Being compassionate Having patience Making sacrifices

6 Types of costs related to FASD q Health care 30 % q Educational services 24 % q Social services 19 % q Legal/correctional 13 % q Other 14 %

7 Examples of cost items related to FASD in health care From Abel 1987, 1991; Harwood 1985; Klug 2003; Stade 2006, 2009,2009;Fuchs 2009; Thanh/Jonsson/Jacobs 2009 q Neonatal intensive care q Heart defects q Spinal cord defects q Cleft palate q Hearing loss q Hernia q Kidney failure q Hypospadias q Hospitalizations q Emergency room visits q Specialist visits q Other health care visits q Prescription drugs

8 Cost of FASD in Canada 2009 In CAD q Total annual cost 7.6 billion* q Life time cost per case 1.8 million q Annual cost per case of FASD 25,000 q Incremental life time cost 800,000 Source: Clarren, Salmon, Jonsson; Prevention of FASD who is responsible? Wiley Blackwell 2011 Includes cost of health, education, social and correction services, but excludes other cost of the legal system *Direct translation to population of France would mean a total cost of FASD is $ 13,9 billion per year in France

9 Direct annual health care cost of selected diseases and of FASD in Alberta, 2009 CAD q Cardiovascular diseases 774 million q FASD (total 520 million) 230 million q Type 2 diabetes 156 million q Lung cancer 122 million Source: Patra et al (discounted to 2009), Clarren et al 2011

10 Potential return on investment of prevention of one case of FASD 800,000 dollars for each prevented case Current investment on prevention (diagnosing, support and primary prevention) is in general relatively low.

11 Prevention of FASD in Alberta q Numerous initiatives supported by the Government since late 1980s q Cross Ministry Committee on FASD 2003 q 12 Networks for diagnosing, support and primary prevention of FASD q Primary prevention by the PCAP model developed at the University of Washington

12 What are the Networks doing? q Providing diagnostic and support services q Primary prevention (PCAP) The Networks are doing primary and secondary prevention

13 Which outcomes of the Networks are measureable in economic terms? Number of clients served Number of cases of FASD prevented Primary prevention measured in abstinence, and/or effective pregnancy protection Number of people supported to avoid secondary implications of FASD -school disruption -alcohol and drug abuse -crime -homelessness -serious infectious diseases -mental health problems -unemployment

14 Annual cost of the Networks Type of service Cost (million $) Operational 18% 1.5 Support services 40% 3.5 Diagnostic services 19% 1.6 Preventive services (PCAP) 23% 2.0 Total 8.6 Source: Alberta FASD-CMC 2013

15 Outcomes of Primary Prevention (preliminary findings) Number of expected cases of FASD in the high risk population of the Networks 87 Number of cases of FASD Expected cases dealt with by PCAP 56 Number of cases of FASD prevented 31 Cost savings by primary prevention $22 million/year

16 Potential cost savings of secondary prevention CAD Criminal justice average cost of crime 15,000 Shelter cost of homelessness 14,400 Educational cost of school disruption 8,400 Productivity loss; cost of unemployment 7,200

17 Networks impact on secondary disabilities from FASD Depending on effectiveness of the Networks (40 80%) the Networks reduced: 187 to 281 school disruption among children 144 to 289 occurrences of unemployment among adults 297 to 593 of crimes committed 456 to 930 of a mental health episode 74 to 148 occurrences of being homeless Cost savings by secondary prevention $12 million per year

18 Net cost savings CAD yearly savings Primary prevention 22 million Prevention of secondary disabilities 12 million Net cost savings per year 34 million

19 Cost-effectiveness of prevention in FASD -Conclusions 1) FASD prevention is extremely cost-effective The Networks pay for themselves by preventing 5 cases of FASD and achieving only 10 % of what is feasible in prevention of secondary disabilities 2) Very high rate of social return in spite of conservative estimates of outcomes of both primary and secondary prevention, and of the effectiveness of the Networks

20 First International Conference on Prevention of FASD

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22 Monetary benefits of secondary prevention Million $ Average Lower Higher Total Cost if No Networks Total Benefits of the Networks Effectiveness 40% Effectiveness 60% Effectiveness 80% Effectiveness level at which Networks pay for themselves 28% 25%

23 Returns from Preventive Services (PCAP) Average Range Number of prevented FASD cases Incremental cost per prevented FASD case to 43 $102,000 $76,000 to $161,000 Net monetary benefit* (= benefit - cost) $22 million $13 million to $30 million *based on the discounted incremental lifetime cost per case with FASD: $800,000