SynthesisPloS one2021
Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review.
Synthesis in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Burden of Chikungunya Fever and Its Economic and Social Impacts Worldwide: A Systematic Review.Tropical medicine & international health : TM & IH · 2025Pooled it
- Comparing Folic Acid Interventions and Arsenic Reduction Strategies for Neural Tube Defect Prevention in Bangladesh: A Systematic Review and Decision Analysis.Birth defects research · 2025Pooled it
- Maternal folic acid supplementation and the risk of ankyloglossia (tongue-tie) in infants; a systematic review.PloS one · 2023Pooled it
- Folic Acid Therapy is Associated with a Lower Risk of Incident Diabetes and Better Glycemic Status in Patients with Coronary Heart Disease: Findings from a Multicenter Propensity Score-Matched Analysis.Drug design, development and therapy · 2026Article
- The prevalence of neural tube defects in eastern Ethiopia: A population-based surveillance.PLOS global public health · 2026Article
- Neural Protection Through Health Education: Early Childhood Interventions to Prevent Neurological Conditions Requiring Surgical Care.Children (Basel, Switzerland) · 2025Review
- Biological, dietetic and pharmacological properties of vitamin BNPJ science of food · 2025Review
- National strategies for screening neural tube defects in Saudi Arabia: activating prevention and early intervention.Frontiers in public health · 2025Review
- Action against birth defects: if not now, when?Global health action · 2024Article
- Article
- Global heterogeneity in folic acid fortification policies and implications for prevention of neural tube defects and stroke: a systematic review.EClinicalMedicine · 2024Article
- Priority nutrients to address malnutrition and diet-related diseases in Australia and New Zealand.Frontiers in nutrition · 2024Article
- National Diet and Nutrition Survey data reveal a decline in folate status in the United Kingdom population between 2008 and 2019.The American journal of clinical nutrition · 2023Article
- Investigating the pathways from preconception care to preventing maternal, perinatal and child mortality: A scoping review and causal loop diagram.Preventive medicine reports · 2023Article
- Integrated surveillance strategy to support the prevention of neural tube defects through food fortification with folic acid: the experience of Costa Rica.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2023Review
- A Paternal Methylation Error in the Congenital Hydrocephalic Texas (H-Tx) Rat Is Partially Rescued with Natural Folate Supplements.International journal of molecular sciences · 2023Article
- Prevented cases of neural tube defects and cost savings after folic acid fortification of flour in Brazil.PloS one · 2023Article
- Effect of Amino Acids on Folates Accumulation in Wheat Seedlings during Germination under Red Light Radiation.Molecules (Basel, Switzerland) · 2022Article
- Design of Cereal Products Naturally Enriched in Folate from Barley Pearling By-Products.Nutrients · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNeural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs.
objectiveWe aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes.
methodsWe conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis.
resultsA total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 μg/100 g have a higher CBA ratio. The studies with the inclusion of "loss of consumer choice" in the analysis may alter the fortification cost-efficacy ratio.
conclusionWe expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.