Carga Econômica dos Defeitos do Tubo Neural na Perspectiva do Ministério da Saude no período de 2019-2020.
Mandatory flour fortification; neural tube defects; disease burden
In Brazil, congenital anomalies are the second leading cause of death among children under the age of five, and about 24,000 births were reported with some type of birth defect per year. Neural tube defect was one of the most prevalent congenital anomalies in the country between 2010 and 2019. Neural tube diseases result in severe physical and/or mental disabilities that require lifelong rehabilitation generating a significant economic cost to health systems and societies, especially in lowand middle-income countries. Given this, the objective was to estimate the direct costs of neural tube defects from the perspective of the Brazilian Ministry of Health, as well as the cases avoided and the savings generated due to mandatory folic acid fortification in the period 2010-2019. This is a topdown cost-of-disease study based on the prevalence of tube defects in Brazil. Data were collected from the databases of the outpatient and hospital information system of the Ministry of Health. Direct cost was estimated from total patient-years, allocated by age and type of disorder. Cases averted and cost savings were determined by the difference in the prevalence of disorders in the pre- and postfortification periods based on the total number of births and the sum of outpatient and inpatient costs during the period. The total cost of outpatient and hospital services for these disorders totaled R$92,530,810.63 (Int$40,565,896.81) over 10 years; spina bifida accounted for 84.92% of the total cost. Hospital costs were significant for all three disorders in the first year of life. Between 2010 and 2019, mandatory folic acid fortification prevented 3,499 live births with neural tube defects and resulted in R$20,381,586.40 (Int$8,935,373.25) in hospital and outpatient cost savings. Costeffectiveness analysis could not be performed due to lack of information on the cost and process used to fortify flours in Brazil. Flour fortification has proven to be a valuable primary prevention strategy in preventing pregnancies with neural tube defects. Since its implementation, there has been a 30% decrease in the prevalence of neural tube defects and an associated 22.81% decrease in hospital and outpatient costs.