Greenmyer JR, et al. - The literature on the costs of and savings from prevention of Fetal alcohol spectrum disorder (FASD) was reviewed and a model for the US and Canada of projected savings based on the expansion of existing evidence-based prevention models was presented. Researchers conducted a systematic review of published literature on the cost of FASD prevention and interviewed experts in the field. Evidence-based prevention programs were applied to women at the highest risk to have a future child with fetal alcohol syndrome leading to the reduction in the cost of prevention of one case by $1,215,600 in the US. This is a 62 fold cost savings compared with the cost of preventing one case among all women who drink. These findings support the expansion of risk-based prevention strategies for fetal alcohol spectrum disorder in the US and Canada as economically efficient and worthwhile for society.