Lifetime Costs Calculated for Birth Defects : Health: The figure for a California child with cerebral palsy nears $500,000, researchers say. They urge investment of funds in study of causes and prevention.

One in every 33 infants born in California has a severe birth defect and the costs of medical and educational care for such children can be staggering, according to a new state-funded study, the first to examine such lifetime costs.

The direct medical and supportive costs for an individual with a birth defect such as cerebral palsy approach half a million dollars, while the cumulative costs for the state run into the hundreds of millions of dollars, according to a study published today in the journal Inquiry.

On an individual basis, birth defects are as costly or more costly than life-threatening diseases, such as cancer and heart disease, but proportionately far less money is spent researching their causes and prevention, according to economist Norman J. Waitzman of the University of Utah, who led the study under a contract from the California Department of Health Services.

“We spend only about $60 million per year on birth defects research in the United States, but several billions on cancer,” Waitzman said. “We could get more bang for the buck” by increasing the amount spent on the search for the causes of birth defects, he said.

“Investing now in finding the cause of birth defects will save millions of dollars in the future,” said Dr. John Harris, chief of the California Birth Defects Monitoring Program.

Waitzman emphasized that the cost estimates are extremely conservative and do not include the emotional and indirect costs of birth defects, such as parents’ time lost from work. “When those are included, the costs are much, much higher,” he said.

The California birth defects program, unique in the country and a source of some of the data used in the study, monitors more than 300,000 births per year, tracking birth defects and trends with its registry. The state “is ahead of the nation in having a birth defects surveillance system,” according to Dr. Jennifer L. Howse, president of the March of Dimes Birth Defects Foundation. Expanding the program nationwide could lead to much better understanding of the causes of birth defects, she added.

The new study is based on births from 1988. Waitzman’s teams estimated the cumulative costs of direct medical care, special educational costs and supportive care, which includes community services, nursing care in the home and specialized transportation costs such as school busing for the handicapped. They used Medicare and Medi-Cal costs in their calculations, which are often substantially lower than the costs incurred by private insurance companies.

In 1988, there were 657 California children born with cerebral palsy, for example, an incidence of about 1.23 cases per 1,000 births (about the same as the national average). The projected lifetime cost for care of these children was $445,000 per person, Waitzman calculated. For the 657 cases, that totals more than $292 million.

For the 558 children born with Down’s syndrome, the projected cost per child was estimated at $410,000, for a total of more than $228 million.

Waitzman and others hope that more research will reveal the causes of Down’s syndrome and other birth defects whose origins remain unknown. But researchers can already use the findings to evaluate the benefits of prevention programs for those few cases where information is available about causes, according to Sonja Bentley, community services manager for the birth defects program.

Researchers know, for example, that feeding supplements of folic acid to pregnant women can reduce the incidence of neural tube defects, such as spina bifida, and federal officials have proposed that bread and flour be supplemented with the vitamin. Waitzman has already used the new data to calculate cost/benefit ratios for the proposed program and expects to publish his results shortly.