Estimating the lifetime costs associated with maternal alcohol consumption during pregnancy

OBJECTIVES: Maternal alcohol consumption during pregnancy is a major, yet preventable, risk factor for fetal alcohol spectrum disorders (FASD), which can lead to lifelong neurodevelopmental, educational, and social challenges. The economic burden of FASD in Germany remains poorly quantified. In this study, we aimed to estimate the direct and indirect lifetime costs associated with FASD in Germany. STUDY DESIGN: Static cohort-based cost-of-illness study. METHODS: We conducted a cost-of-illness analysis from the perspectives of the German healthcare (e.g., psychiatric care) and social (e.g., alternative housing, special education) systems. Data from German and international studies were used to derive age-specific annual costs, which were applied to a modeled cohort of 12,600 and 13,500 individuals with FASD in Baden-Württemberg. Lifetime costs were calculated from birth to the German retirement age (67 years), adjusted to inflation in 2024, and discounted at 0%, 3%, and 5% per annum. RESULTS: The estimated undiscounted lifetime cost per affected individual was EUR 3.9 million, corresponding to EUR 49.6-53.1 billion for a single birth cohort, depending on the assumed prevalence. Applying a 3% discount rate reduced the present value to EUR 1.5 million per individual and EUR 18.4-19.8 billion for the birth cohort, while a 5% discount rate further decreased these estimates to EUR 0.9 million per individual and EUR 11.1-11.9 billion. CONCLUSIONS: FASD represents a significant lifetime economic burden in Germany. Both undiscounted and discounted estimates underscore the importance of early preventive interventions, improved screening, and targeted support to reduce long-term costs for healthcare, social services, and society.