The Costs and Benefits of Folic Acid Fortification in the United States: A Comparison of Ex Ante and Ex Post Economic Evaluations

The United States Food and Drug Administration (FDA) required that manufacturers of enriched cereal-grain products as of January 1, 1998 fortify their products with folic acid to reduce the number of pregnancies affected a by neural tube defect (NTD). Prior to adoption of the regulation in 1996, three economic evaluations projected net economic benefits or cost savings from folic acid fortification. The expected decline in NTDs was between 2.6% and 10.5%. Birth defects surveillance data indicate a decline of 20% to 30% in births with spina bifida or anencephaly following fortification. We conservatively estimate that the folic acid fortification results in an economic benefit of $425 million per year in the United States, constituting a major regulatory public health success.