Diagnosing Fetal Alcohol Syndrome: Economic and Policy Implications

Fetal Alcohol Syndrome (FAS) is a range of physical and neurobehavioral disabilities that is the result of maternal alcohol consumption during pregnancy. FAS and its related disabilities are significant socio-economic concerns to Canadians and is thought to be prevalent in Saskatchewan. Often, diagnosis is necessary for access to services that will improve outcome of affected individuals and their families. This thesis was designed to determine an estimate of some economic costs associated with Fetal Alcohol Syndrome and its related disabilities to Saskatchewan and to determine why (and if) FAS is underdiagnosed in Saskatchewan. Economic costs to social services, justice, education, and health were estimated using provincial budgets and estimated prevalence rates of Fetal Alcohol Syndrome and its related disabilities. A case-based method was also used. The economic estimates suggested that prenatal alcohol exposure is costing the province of Saskatchewan $41.1 million per year. More specifically, costs to social services, justice, education, and health were estimated to be $5.9 million, $17.6 million, $0.26 million, and $20.3 million, respectively. Based upon population estimates, the total costs of FAS and its related disabilities to Saskatchewan may reach $XX million by the year 2021. Physicians, especially general practitioners, are often the first line of contact for FAS affected individuals and their families. Previous data suggest that physicians may not feel comfortable caring for affected individuals and their families, nor do they have the knowledge necessary to make effective and reliable FAS-related diagnoses or referrals for diagnosis. Study 2 was designed to determine the knowledge and attitudes of Saskatchewan general practitioners with respect to FAS and its related disabilities. Survey questions were based upon a survey performed in 1992. Data suggest that FAS is underdiagnosed in Saskatchewan and that general practitioners do not feel comfortable caring for affected individuals or their families. Data also suggest that Saskatchewan general practitioners do not have adequate knowledge to make effective FAS diagnoses or referrals, although some report that they have diagnosed FAS. There were no significant effects of place of practice, university appointment, or graduation year on knowledge about FAS. Finally, data suggest that, in a ten-year period, knowledge levels with respect to FAS have not increased but the number of physicians making referrals for diagnosis has increased. Together these data suggest that FAS costs Saskatchewan a significant number of dollars and that effective intervention programs may mitigate some of these costs. However, services are based upon need, and need is defined through comprehensive diagnostic assessments, but physicians need more education and training with respect to the diagnosis of FAS and its related disabilities