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Table 1. Estimates of the Total U.S. Annual Cost of Fetal Alcohol Syndrome Ranked by Prevalence Rate

Source Prevalence Rate (per 1,000) Annual Cost Year Types of Services Included
Abel and Sokol 0.33 $75 million 1984 A1, B1
Harwood and Napolitano 1.67 $3.235 billion 1980 A2, B2, B3, C, D
Abel and Sokol 1.9 $321 million 1984 A1, B1
Abel and Sokol 1.9 $250 million 1987 A1, B1
Rice, et al. 1.9 $1.611 billion 1985 A1, B4
Rice; update of 1985 study 1.9 $2.089 billion 1990 A1, B4
Harwood, et al. 2.0/1.0* $2.934 billion 1992 A3, B2, B3, D
Harwood; update of 1992 study 2.0/1.0* $4.022 billion 1998 A3, B2, B3, D

Service Codes

Service Code Description
A1 Medical treatment services to age 21 for pre- and postnatal growth retardation, heart defects requiring surgery, spina bifida, cleft palate, surgery and treatment for audiologic deficits, inguinal hernia, and hypospadias
A2 Medical treatment services to age 21 for pre- and postnatal growth retardation, heart defects requiring surgery, cleft palate, surgery and treatment for audiologic deficits, kidney defects, and neural tube defects
A3 Medical treatment services to age 21 for pre- and postnatal growth retardation, cleft palate, surgery and treatment for audiologic deficits, and neural tube defects
B1 Residential care due to mental retardation for ages 5 to 21
B2 Residential and home care for mild to moderate mental retardation for ages 22 to 65
B3 Institutionalization for severe mental retardation for ages 5 to 65
B4 Residential care and support services for persons with mild to moderate mental retardation over the age of 21 and full residential care for persons with severe mental retardation over the age of 5
C Special education resource room for individuals with minimal brain dysfunction for ages 5 to 18 and ambulatory care with special education for ages 3 to 21
D Lost employment and reduced productivity

Table 2. 2002 U.S. Annual Cost Adjusted by Population Growth and Inflation

Source Type of Cost Costs (in billions) Year Percent Increase in Population* Percent Change in Inflation† 2002 Adjusted Estimate‡
(in billions)
Abel and Sokol Treatment costs for medical services $0.017 1984 1.223 2.745 $0.06
Residential care for mental retardation $0.058 1.223 1.731 $0.12
Total $0.075     $0.18
Harwood and Napolitano Treatment costs for medical services $1.209 1980 1.269 3.916 $6.01
Residential care for mental retardation $1.174 1.269 2.183 $3.25
Lost productivity $0.853 1.269 2.218 $2.40
Total $3.235     $11.66
Abel and Sokol Treatment costs for medical services $0.135 1984 1.223 2.745 $0.45
Residential care for mental retardation $0.186 1.223 1.731 $0.39
Total $0.321     $0.85
Abel and Sokol Treatment costs for medical services $0.105 1987 1.190 2.253 $0.28
Residential care for mental retardation $0.145 1.190 1.584 $0.27
Total $0.250     $0.55
Rice, et al Treatment costs for medical services $0.138 1985 1.212 2.587 $0.43
Residential care for mental retardation $1.473 1.212 1.672 $2.99
Total $1.611     $3.42
Harwood, et al. Treatment costs for medical services $0.600 1992 1.124 1.537 $1.04
Residential care for mental retardation $1.344 1.124 1.282 $1.94
Lost productivity $0.990 1.124 1.397 $1.56
Total $2.934     $4.53

*Population change is determined using U.S. population figures from the Bureau of the Census for July 1 of each year.

†Inflation change is determined based on the Medical Services Price Index from the Bureau of Labor Statistics for treatment services, the Consumer Price Index for care, and the Average Hourly Wage for Production Workers for productivity.

‡Totals may vary due to rounding.

Table 3. Comparable Adjusted Estimates of the Total 2002 U.S. Annual Cost for Treatment and Care Costs Only Based on Prevalence Rate of 2/1,000 and Residential Care for Mentally Retarded Individuals of All Ages

Source

Adjusted Estimates (in billions) Increase Factor for Prevalence Rate Increase Factor for Residential and Support Care for Mentally Retarded Age 21+ Normalized Estimates of Annual Cost(in billions)
Abel and Sokol, 1984 $0.18 6.061 4 $4.7
Harwood and Napolitano, 1980 $5.45 2 1 $11.1
Harwood and Napolitano, 1980 $9.26 1.198 1 $11.1
Abel and Sokol, 1984 $0.85 1.053 4 $3.6
Abel and Sokol, 1987 $0.55 1.053 4 $2.3
Rice, et al., 1985 $3.42 1.053 1 $3.6
Harwood, et al., 1992 $4.53 1 1 $4.5

Note: Total may vary slightly due to rounding of estimated total 2002 U.S. annual costs, as well as the increase factors for prevalence rate and mental retardation care.

Table 4. Estimates of the Total U.S. Lifetime Cost of Each Child with FAS

Source of Estimate Date Costs Included Undiscounted Estimate of Total U.S. Lifetime Cost of Child With FAS
Harwood and Napolitano1 1980 A1, B1, C, D, F

$596,000

Alaska State Legislature 1988 A2, B2, C, E, F

$1,373,836

Service Codes

Service Code Description
A1 Medical treatment services to age 21 for pre- and postnatal growth retardation, heart defects requiring surgery, spina bifida, cleft palate, surgery and treatment for audiologic deficits, inguinal hernia and hypospadias
A2 Medical treatment costs for pre- and postnatal growth retardation, heart defects requiring surgery, cleft palate, and surgery and treatment for audiologic deficits
B1 Ambulatory, home and residential care for individuals with mild to moderate mental retardation
B2 Infant learning, handicapped children, youth initiative, and developmentally disabled children's services
C Special education services
D Lost employment and reduced productivity
E Social service costs, such as training and supervised work services
F Institutional care for mental retardation to age 65

Sources

  1. Harwood, H.J., and Napolitano, D.M. 1985. Economic implications of the fetal alcohol syndrome. Alcohol Health & Research World, 10(1):38-43; 74-75.
  2. Abel, E.L., and Sokol, R.J. 1987. Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies. Drug and Alcohol Dependence, 19:1024-1031.
  3. Rice, D.P.; Kelman, S.; Miller, L.S.; et al. 1990. The Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985. DHHS Publication No. (ADM) 90-1694. Rockville, MD: U.S. Department of Health and Human Services.
  4. Abel, E.L., and Sokol, R.J. 1991. A revised estimate of the economic impact of fetal alcohol syndrome. In: Galanter, M. (ed.). Recent Developments in Alcoholism: Volume 9, Children of Alcoholics. New York: Plenum Press, pp 117-125.
  5. Abel, E.L., and Sokol, R.J. 1991. A revised conservative estimate of the incidence of FAS and its economic impact. Alcoholism: Clinical and Experimental Research, 15:514-524.
  6. Streissguth, A.P. 1991. What every community should know about drinking during pregnancy and the lifelong consequences for society. Substance Abuse, 12(3):114-127.
  7. Rice, D.P. 1993. The economic costs of alcohol abuse and dependence: 1990. Alcohol Health & Research World, 17(1):10-11.
  8. Harwood, H.; Fountain, D.; and Livermore, G. 1998. The Economic Costs of Alcohol and Drug Abuse in the United States, 1992. Washington, DC: National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism.