Are the “Best Buys” for Alcohol Control Still Valid? An Update on the Comparative Cost-Effectiveness of Alcohol Control Strategies at the Global Level
Evidence on the comparative cost-effectiveness of alcohol control strategies is a relevant input into public policy and resource allocation. At the global level, this evidence has been used to identify so-called best buys for noncommunicable disease prevention and control.
This article uses global evidence on alcohol use exposures and risk relations, as well as on intervention costs and impacts, to re-examine the comparative cost-effectiveness of a range of alcohol control strategies.
A “generalized” approach to cost-effectiveness analysis was adopted. A new modeling tool (OneHealth) was used to estimate the population-level effects of interventions.
Interventions that reduce the alcohol use and related harm included brief psychosocial interventions, excise taxes, and the enactment as well as enforcement of restrictions on alcohol marketing, availability, and driving under the influence of alcohol laws.
Costs were estimated in international dollars for the year 2010 and effects expressed in healthy life years gained. Analysis was carried out for 16 countries spanning low-, middle-, and high-income settings.
Increasing excise taxes has a low cost (<I$0.10 per capita) and a highly favorable ratio of costs to effects (<I$100 per healthy life year gained in both low- and high-income settings).
Availability and marketing restrictions are also highly cost effective (<I$100 in low-income settings and <I$500 in high-income settings).
Enforcement of driving under the influence of alcohol laws and blood alcohol concentration limits via sobriety checkpoints had cost-effectiveness ratios in the range of I$1,500–3,000.
Brief psychosocial treatments were <I$150 and <I$1,500 in low- and high-income settings, respectively.
More than a decade after an initial global analysis, the findings of this study indicate pricing policies and restrictions to alcohol availability and marketing continue to represent a highly cost-effective use of resources.
Research in context
Tax increases are the single most cost-effective way of diminishing demand and reining back consumption,” said Dr. Dan Chisholm lead researcher of the study from the Department of Mental Health and Substance Abuse at the World Health Organization in Geneva, Switzerland, as per Science Daily.Dr. Dan Chisholm, lead researcher of the study, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
As reported by Science Daily, the findings show that a 50% increase in alcohol excise taxes would cost less than the equivalent of USD$100 for each healthy year of life gained in the overall population and would add 500 healthy years of life for every 1 million people. To put that tax increase in perspective, it might represent mere pennies per alcoholic beverage. According to a study in the January issue of the journal, state excise taxes in America average only three cents per 12 oz. beer or 5 oz. glass of wine and only five cents for an alcoholic beverage with 1.5 oz. of hard liquor.
Restricting hours of operation for off-premise alcohol retailers or implementing and enforcing strong restrictions/bans on alcohol advertising (on the Internet, radio, television, and billboards) each would also cost less than $100 per healthy year of life gained and would add up to 350 healthy life years for every 1 million people in the population.
The report’s authors note that they likely underestimated the benefits of improved alcohol control strategies. Their study did not look at effects such as reduced property damage or better productivity at work, among other likely benefits of less overall alcohol consumption in the population.
[We hope these findings would] guide decision makers toward a more rational and targeted use of available resources . . . for addressing the substantial and still growing burden of disease attributable to alcohol use,” stated the authors in the study as per Science Daily.Dan Chisholm, Daniela Moro, Melanie Bertram, Carel Pretorius, Gerrit Gmel, Kevin Shield, Jürgen Rehm, authors of the study