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Module 7: Costs of Fetal Alcohol Spectrum Disorders

Gaps in Knowledge About the Cost of FAS

Much of the work to estimate the cost of FAS recognizes that individuals with FAS are simply one part of the continuum of conditions caused by prenatal alcohol exposure. They represent the tip of the iceberg. Other babies born with ARBD and ARND make up a much larger group. It is estimated that while the rate of FAS is 0.5 to 2 per 1,000 live births, FAS, ARBD, and ARND combined account for as many as 10 per 1,000 live births,11 or five times as many cases as FAS.12

Female professional sitting at a desk reviewing data

A number of specific cost categories are generally not included in annual and lifetime costs. However, inclusion of these costs would provide a more accurate picture. Examples of excluded costs include costs related to involvement with the juvenile and criminal justice system, special education, and substance abuse, mental health, and vocational services. For example, individuals with FAS often become involved with the juvenile and criminal justice systems. One study found that 60 percent of subjects with an FASD had been in trouble with the authorities, charged with a crime, or convicted of a crime.13 However, most cost estimates do not include law enforcement costs.

Finally, annual and lifetime cost estimates are based on national statistics about the incidence and prevalence of FAS. Costs may be more concentrated for communities with higher rates of alcohol use where the prevelance might be higher.

In addition, some individuals receive inappropriate services and cycle through service systems and incur more costs than necessary. In other cases, they do not receive services at all. Therefore, no associated costs are included for service delivery. In either case, calculating true costs becomes difficult.

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