Reevaluating the benefits of folic acid fortification in the United States: economic analysis, regulation, and public health

Am J Public Health. 2005 Nov;95(11):1917-22. doi: 10.2105/AJPH.2004.058859. Epub 2005 Sep 29.


Before a 1996 US regulation requiring fortification of enriched cereal-grain products with folic acid, 3 economic evaluations projected net economic benefits or cost savings of folic acid fortification resulting from the prevention of pregnancies affected by a neural tube defect. Because the observed decline in neural tube defect rates is greater than was forecast before fortification, the economic gains are correspondingly larger. Applying both cost-benefit and cost-effectiveness analytic techniques, we estimated that folic acid fortification is associated with annual economic benefit of 312 million dollars to 425 million dollars. The cost savings (net reduction in direct costs) were estimated to be in the range of 88 million dollars to 145 million dollars per year.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cost Savings
  • Cost-Benefit Analysis
  • Edible Grain
  • Female
  • Folic Acid / economics*
  • Folic Acid / therapeutic use
  • Health Policy / legislation & jurisprudence
  • Hematinics / economics*
  • Hematinics / therapeutic use
  • Humans
  • Neural Tube Defects / economics
  • Neural Tube Defects / epidemiology
  • Neural Tube Defects / prevention & control
  • Pregnancy
  • Pregnancy Outcome / economics
  • Pregnancy Outcome / epidemiology
  • Public Health Practice / economics*
  • Public Health Practice / legislation & jurisprudence
  • United States / epidemiology


  • Hematinics
  • Folic Acid