Main Article Content

Svetlana Popova
Brenda Stade
Shannon Lange
Jürgen Rehm


Fetal alcohol spectrum disorder (FASD), fetal alcohol syndrome (FAS), economic cost, methodology



Fetal alcohol spectrum disorder (FASD) is a group of disorders with lifelong disabilities that require a large amount of support from various services including health, community, remedial education, and many others. Thus, FASD has a huge economic and societal impact.



To develop a sound methodology for calculating a comprehensive, evidence-based picture of the economic impact of FASD for Canada.



The economic model was developed within the framework of the revised International Guidelines for Estimating the Costs of Substance Abuse. In addition, the Guidelines generated during the first national Roundtable held by the Public Health Agency of Canada were employed. The methodologies of the few existing studies on the economic cost of FASD from Canada and USA were also considered.



A new and comprehensive methodology for estimating of the economic impact of FASD is presented. The model includes the direct and indirect costs associated with the experiences of those affected by FASD, as well as those of their families/caregivers during multiple life/developmental stages. Preliminary cost estimates for the main cost drivers for Canada are presented.



The developed methodology is appropriate for use in Canada, and has the potential to be used by other countries. The challenges associated with implementing the economic model and estimating the economic costs of FASD are discussed, as are the levels of analysis.

Abstract 396 | PDF Downloads 161


1. Abel EL, Sokol RJ. Incidence of fetal alcohol syndrome and economic impact of FASrelated anomalies. Drug Alcohol Depend 1987;19:51-70.
2. Harwood H. Updating estimates of the economic costs of alcohol abuse in the United States: Estimates, update methods, and data. Report prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcoholism. Based on estimates, analyses, and data reported in H. Harwood, D. Fountain and G. Livermore G, The economic costs of alcohol and drug abuse in the United States, 1992. Report prepared for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services. NIH Publication No. 98-4327. Rockville, MD: National Institutes of Health, 2000.
3. Legge C, Roberts G, Butler M. Situational analysis. Fetal alcohol syndrome/fetal alcohol effects and the effects of other substance use during pregnancy. Ottawa, Canada: Health Canada, 2001.
4. Lupton C, Burd L, Harwood R. Cost of fetal alcohol spectrum disorders. Am J Med Genet C Semin Med Genet 2004;127C:42-50.
5. Public Health Agency of Canada (PHAC). Fetal alcohol spectrum disorder (FASD): A framework for action. Ottawa, Canada: PHAC, 2003.
6. Public Health Agency of Canada (PHAC). Alcohol use and pregnancy: an important Canadian public health and social issue. Ottawa, Canada: PHAC, 2005.
7. Stade B, Ali A, Bennett D, et al. The burden of prenatal exposure to alcohol: revised measurement of cost, 2007. Can J Clin Pharmacol 2009;16:e91-e102.
8. Popova S, Stade B, Bekmuradov D, Lange S, Rehm J. What do we know about the economic impact of fetal alcohol spectrum disorder? A systematic literature review. Alcohol and Alcoholism 2011; 46:490-97.
9. Stade B, Ungar W, Stevens B, et al. The burden of prenatal exposure to alcohol: measurement of cost. J FAS Int 2006;4:1–14.
10. Thanh N, Jonsson E. Costs of fetal alcohol spectrum disorder in Alberta, Canada. Can J Clin Pharmacol 2009;16:e80–e90.
11. Abel EL, Sokol RJ. A revised estimate of the economic impact of fetal alcohol syndrome. In Glanter M (ed). Recent Developments in Alcoholism: Children of Alcoholics, Vol. 9. New York: Plenum Press, 117–25, 1991.
12. Abel EL, Sokol RJ. A revised conservative estimate of the incidence of FAS and its economic impact. Alcohol Clin Exp Res 1991;15:514–24.
13. Harwood H. Economic costs of fetal alcohol syndrome [Power Point Presentation]. Prepared for the Lewin Group. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, 2003. Available from http://www.fasdcenter.samhsa.gov/documents /Rick HarwoodPresentation.pdf.
14. Harwood H, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the United States, 1992. Rockville, MD: National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 1998.
15. Harwood H, Napolitano DM, Kristiansen PL, Collins JJ. Economic costs to society of alcohol and drug abuse and mental illness: 1980 (NCJ 117820). Alcohol, Drug Abuse and Mental Health Administration, Rockville, MD, 1984.
16. Harwood H, Napolitano DM. Economic implications of the fetal alcohol syndrome. Alcohol Health Res World 1985;10:38–43.
17. Rice DP. The economic cost of alcohol abuse and alcohol dependence: 1990. Alcohol Health Res World 1993;17:10–11.
18. Rice D, Kelman S, Miller L. 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, 1990.
19. Rice D, Kelman S, Miller L. Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Rep 1991;106:280–92.
20. Weeks M. Economic Impact of Fetal Alcohol Syndrome, IR 89–100015. Memorandum to Senator John Binkeley, February 17. Juneau, Alaska: Senate Advisory Council, Alaska State Legislature, 1989.
21. Public Health Agency of Canada (PHAC). National Roundtable on the development of a Canadian model for calculating the economic impact of FASD. A discussion paper. Ottawa, ON: PHAC, 2008. Available from http://www.phac-aspc.gc.ca/hp-ps/dcadea/ prog-ini/fasd-etcaf/publications/pdf/eime07- eng.pdf.
22. Single E, Collins D, Easton B, et al. International guidelines for estimating the costs of substance abuse, 2nd edition. WHO, Geneva, Switzerland, 2003.
23. Collins DJ, Lapsley HM. Counting the cost: estimates of the social costs of drug abuse in Australia 1998-99. National Drug Strategy Monograph Series no. 49. Canberra, Australia, Commonwealth Dept of Health and Ageing, 2002.
24. Markandya A, Pearce D. The social costs of tobacco smoking. British Journal of Addiction 1989;84:1139-50.
25. Koopmanschap MA, Rutten FF. A practical guide for calculating indirect costs of disease. Pharmacoeconomics 1996;10:460-6.
26. Canadian Coordinating Office For Health Technology Assessment Guidelines For The Economic Evaluation Of Pharmaceuticals: Canada, 2nd Edition. Ottawa, ON: Canadian Coordinating Office For Health Technology Assessment, 1997.
27. Burd L, Klug MG, Martsolf JT, Kerbeshian J. Fetal alcohol syndrome: neuropsychiatric phenomics. Neurotoxicol Teratol 2003;25:697-705.
28. Clarren S, Astley S. Development of the FAS Diagnostic and Prevention Network in Washington State. In: Streissguth A.P. & Kanter J.(eds.), The Challenge of Fetal Alcohol Syndrome. (pp. 40-51). University Washington Press, Seattle, WA, 1997.
29. May PA, Brooke L, Gossage JP, et al. Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape province. Am J Public Health 2000;90:1905-12.
30. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with fetal alcohol spectrum disorder. Clinical Neuropsychology 2006;12:452-68.
31. Sayal K, Heron J, Golding J, Emond A. Prenatal alcohol exposure and gender differences in childhood mental health problems: A longitudinal population-based study. Pediatrics 2007;119:426-34.
32. Sayal K, Heron J, Golding J, et al. Binge patterns of alcohol consumption during pregnancy and childhood mental health outcomes: Longitudinal population-based study. Pediatrics 2009;123: 289-96.
33. Autti-Ramo I, Fagerlaud A, Ervalahti N, Loimu L, Korkman M, Hoyme HE. Fetal alcohol spectrum disorders in Finland. Am J Med Genet 2006;140A:137-43.
34. Kvigne VL, Leonardson GR, Neff-Smith M, Brock E, Borzelleca J, Welty TK. Characteristics of children who have full or incomplete fetal alcohol syndrome. J Pediatr 2004;145:635-40.
35. World Health Organization (WHO). International statistical classification of diseases and related health problems, tenth revision (ICD-10). Geneva, 2004.
36. Rehm J, Baliunas D, Brochu S, et al. The costs of substance abuse in Canada 2002. ISBN 1-897321-10-4. Ottawa, Canada: Canadian Centre on Substance Abuse, 2006.
37. Rehm J, Gnam W, Popova S, et al. The social costs of alcohol, illegal drugs and tobacco in Canada 2002. J Stud Alcohol Drugs 2007;68:886-95.
38. Taylor B, Rehm J, Patra J, Popova S, Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada 2002: recommendations for policy and prevention. J Stud Alc 2007;68: 36-47.
39. Fast DK, Conry J, Loock CA. Identifying fetal alcohol syndrome among youth in the criminal justice system. J Dev Behav Pediatr 1999;20:370-2.
40. MacPherson P, Chudley AE. Fetal Alcohol Spectrum Disorder (FASD): Screening and estimating incidence in an adult correctional population. Presented at the 2nd International Conference on Fetal Alcohol Spectrum Disorder: Research, Policy, and Practice Around the World. Victoria, British Columbia, March 7-10, 2007.
41. Murphy A, Chittenden M, The McGeary Centre Society. Time out II: A profile of BC youth in custody. The McCreary Centre Society, Vancouver, BC, 2005.
42. Streissguth AP, Kanter J. The challenges of Fetal Alcohol Syndrome: Overcoming secondary disabilities. Seattle, WA: University of Washington Press, 1997.
43. Fast DK, Conry J. Fetal alcohol spectrum disorders and the criminal justice system. Dev Disabil Res Rev 2009;15:250-7.
44. Boland FJ, Grant BA. The challenge of Fetal Alcohol Syndrome in adult offender population. Forum on Corrections Research 2002;14:61-4.
45. Fast DK, Conry J. The challenge of fetal alcohol syndrome in the criminal legal system. Addict Biol 2004;9:161-8.
46. Burd L, Klug MG, Li Q, Kerbeshian J, Martsolf JT. Diagnosis of fetal alcohol spectrum disorders: a validity study of the fetal alcohol syndrome checklist. Alcohol 2010;44:605-14.
47. The Asante Centre for Fetal Alcohol Syndrome. The Asante Centre for Fetal Alcohol Syndrome. Youth Probation Officers' Guide to FASD Screening and Referral, 2010. Available from http://www.asantecentre.org/_Library/docs/Yo uth_Probation_Officers_Guide_to_FASD_Scr eening_and_Referral_Printer- Friendly_Format_.pdf.
48. Popova S, Lange S, Mihic A, Bekmuradov D, Rehm J. Fetal alcohol spectrum disorder prevalence estimates in correctional systems: A systematic literature review. Can J Public Health 2011;102: 336-40.
49. Statistics Canada. The Daily Statistics Canada. Adult and youth correctional services: Key indicators, 2008/2009 (correction). Catalogue 11-001-XIE (Français 11-001-XIF) ISSN 1205-9137. Ottawa, ON: Statistics Canada, 2009.
50. Canadian Centre for Justice Statistics. Adult correctional services in Canada, 2008/2009, Vol. 30, no. 3 (85-002-X). Ottawa, ON: Statistics Canada, Canadian Centre for Justice Statistics, 2009.
51. Fuchs D, Burnside L, Marchenski S, Mudry A, De Riviere L. Economic impact of children in care with FASD, phase 1: Cost of children in care with FASD in Manitoba. Ottawa, ON: Centre of Excellence for Child Welfare, 2008.
52. Popova S, Stade B, Johnston M, et al. Evaluating the cost of fetal alcohol spectrum disorder. J Stud Alcohol Drugs 2011;72:163- 64.

Most read articles by the same author(s)