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Nguyen Xuan Thanh
Jessica Moffatt
Philip Jacobs
Anderson W Chuck
Egon Jonsson


Fetal alcohol spectrum disorder, secondary disabilities, cost-benefit analysis, Alberta FASD Service Networks


To estimate the break-even effectiveness of the Alberta Fetal Alcohol Spectrum Disorder (FASD) Service Networks in reducing occurrences of secondary disabilities associated with FASD.

The secondary disabilities addressed within this study include crime, homelessness, mental health problems, and school disruption (for children) or unemployment (for adults). We used a cost-benefit analysis approach where benefits of the service networks were the cost difference between the two approaches: having the 12 service networks and having no service network in place, across Alberta. We used a threshold analysis to estimate the break-even effectiveness (i.e. the effectiveness level at which the service networks became cost-saving).

If no network was in place throughout the province, the secondary disabilities would cost $22.85 million (including $8.62 million for adults and $14.24 million for children) per year. Given the cost of network was $6.12 million per year, the break-even effectiveness was estimated at 28% (range: 25% to 32%).

Although not all benefits associated with the service networks are included, such as the exclusion of the primary benefit to those experiencing FASD, the benefits to FASD caregivers, and the preventative benefits, the economic and social burden associated with secondary disabilities will “pay-off” if the effectiveness of the program in reducing secondary disabilities is 28%.

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1. Sampson PF, Streiguth AP, Bookstein FL, Little RE, Clarren SK, Dehaene P, Hanson JW, Graham JM. Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorders. Teratology 1997;56:317-326.
2. Human Services, Alberta Government. Alberta recognizes international fetal alcohol spectrum disorder awareness day. Information Bulletin 2012. Available at: http://health.groups.yahoo.com/group/fasdnews/message/8814 (Accessed June 11, 2013).
3. Thanh NX, Jonsson E, Dennett L, Jacobs P. Costs of FASD. In: Riley EP, Clarren S, Weinberg J, and Jonsson E (Eds). Fetal Alcohol Spectrum Disorder - Management and Policy Perspectives of FASD. Wiley-Blackwell 2011; Pages 45-69.
4. Streissguth AP, Barr HM, Kogan J & Bookstein FL. Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE), Final Report to the Centers for Disease Control and Prevention (CDC), August, 1996, and Seattle: University of Washington, Fetal Alcohol & Drug Unit, Tech. Rep. No. 96-06, (1996).
5. Alberta FASD Service Networks. Alberta FASD service networks- provincial evaluation report 2012. Available at: http://fasd.alberta.ca/documents/ (Accessed on June 11, 2013).
6. Alberta FASD Cross Ministry Committee. FASD Service Network Program, 2009/2010 Annual Report. Available at: http://fasd.alberta.ca/documents/FASD-CMC-Annual-Report-2009-10.pdf (accessed on June 11, 2013).
7. Alberta FASD Cross-Ministry Committee. FASD Adult Assessment and Diagnosis Discussion Paper 2009. Available at: http://fasd.alberta.ca/documents/FASD-Adult-Asmt-Diagnosis.pdf (Accessed on June 11, 2013).
8. Drummond M, et al. Methods for the Economic Evaluation of Health Care Programmes. Third Edition. Oxford Medical Publication 2005; Chapter 7 - Cost-benefit analysis: pg 211-40.
9. Alberta Human Services. Alberta Wage and Salary Survey Overview 2011. Available at: http://employment.alberta.ca (Accessed on July 16, 2012).
10. Briggs A, Claxton K, and Sculpher M. Decision Modelling for Health Economic Evaluation. Oxford University Press 2006: Chapter 3. Further developments in decision analytic models for economic evaluation. pgPgs 45-76.
11. Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev and Behav Pediatr 2004;25(4):228-38.
12. Folsom DP, Hawthorne W, Lindamer L, et al. Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am J Psychiatry 2005;162:370-6.
13. Pei J, Hughes J, Rasmussen C. Mental health issues in fetal alcohol spectrum disorder. Journal of Mental Health 2011;20:438-48.
14. Famy V, Streissguth AP, Unis AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry 1998;155:552-4.
15. Eberle M, et al. Homelessness: Causes & Effects. Volume 3. The Costs of Homelessness in British Columbia 2011. Available at: http://www.housing.gov.bc.ca/pub/Vol3.pdf (Accessed on June 11, 2013).
16. Lim K, Jacobs P, Ohinmaa A, Schopflocher D, Dewa CS. A new population based measure of the economic burden of mental illness in Canada. Chronic Diseases in Canada 2008;28(3):92-98.
17. Calder P, Sobsey D, Jacobs P. Cost of Fetal Alcohol Spectrum Disorder to Alberta Education. Institute of Health Economics 2012. [research document pending publication]
18. Bank of Canada. Inflation Calculator. Available at:http://www.bankofcanada.ca/rates/related/inflation-calculator/?page_moved=1 (Accessed on August 3, 2012).