Mandatory fortification of bread flour with folic acid is found to be a highly effective public health intervention that also improves equity of outcomes among Australian children.

For further information view the study publication: Saing S¹, Haywood P¹, van der Linden N², Manipis K¹, Meshcheriakova E¹, Goodall S¹ (2019) 'Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia.', Applied Health Economics and Health Policy. Early on-line. DOI: 10.1007/s40258-018-00454-3

Affiliations: 1 Centre for Health Economics Research and Evaluation, University of Technology Sydney 2 Erasmus School of Health Policy and Management, Erasmus University Rotterdam

Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. A decision tree model was
developed to compare different fortification strategies and used registry data to quantify the change in neural tube defect rates due to the policy. A societal perspective was adopted that included costs to industry and government as well as healthcare and broader societal costs.

Mandatory folic acid fortification improved health outcomes and we found 32 fewer neural tube defects per year in the post-mandatory folic acid fortification period. Despite the high up-front cost to flour millers and bakers, the total cost of the policy was low per capita. Overall, mandatory folic acid fortification was highly cost effective. The study proves it is extremely likely mandatory fortification has improved health and reduced healthcare costs for the Australian population. This policy showcases the benefits of the healthcare system working with government and industry in delivering a public health approach.