Impact of minimum unit pricing on alcohol-related hospital outcomes: systematic review
Original research
Study overview
Minimum unit pricing (MUP) means setting a floor cost of a standard unit of alcohol. This is a way of increasing the cost of the cheapest packaged alcohol, eliminating ultra cheap alcohol products, anc thus reducing alcohol harm.
On May 1, 2018, Scotland became the first country to enact MUP (£0.50 per eight grams of alcohol) via public health legislation for all alcoholic beverages, followed by the Northern Territory, Australia in October 2018, Wales in 2020 and Ireland in 2022. On January 4,2022, Ireland overcame legislative and lobbying barriers and introduced a €1.00 MUP (£0.67 UK MUP) per standard alcoholic drink or 10 g of alcohol.
In this meta-study, researchers examined 22 previously published papers on minimum unit pricing: 6 natural experiments and 16 modelling studies from Australia, Canada, England, Northern Ireland, Ireland, Scotland, South Africa and Wales.
Few studies have previously evaluated the impact of MUP specifically on hospital burden and inpatient outcomes due to alcohol harm, and the results of such studies have not been collectively reviewed in the literature.
The aim of this original research paper was to provide a comprehensive review on this topic.
Some of the results from the natural experiments
- In British Columbia, Stockwell et al evaluated a 10% increase in the average minimum price (equivalent to a rise from £0.34 to £0.38 UK MUP) which resulted in an immediate 9.0% reduction in acute alcohol-attributable admissions, and a lagged 9.2% reduction in chronic alcohol-attributable hospitalisation at 2 years.
- Zhao and Stockwell later analysed a further 1% increase in average minimum price in British Colombia and demonstrated an immediate 1.6% reduction for ‘100% acute alcohol-related admissions’ across all income subgroups.
- There was a 2.2% reduction in ‘100% chronic alcohol-related admissions’ for low-income groups. All chronic alcohol-related admissions showed a lag of 2–3 years, and the greatest overall effects were consistent in the low-income groups.
- In Northern Territory, Australia, an evaluation of the introduction of a “banned-drinker register” and MUP reported a 4.9% reduction in acute ICU admissions due to alcohol.
Despite different methods being used to study MUP in reducing the alcohol-related healthcare burden, the majority of real-world studies showed consistencies with modelling studies.
According to the researchers, minimum pricing appears to be particularly effective at reducing alcohol-related hospitalisation among the heaviest alcohol consumers and those from the lowest socioeconomic group.
Abstract
Objective
To determine the impact of minimum unit pricing (MUP) on the primary outcome of alcohol-related hospitalisation, and secondary outcomes of length of stay, hospital mortality and alcohol-related liver disease in hospital.
Design
Databases MEDLINE, Embase, Scopus, APA Psycinfo, CINAHL Plus and Cochrane Reviews were searched from 1 January 2011 to 11 November 2022. Inclusion criteria were studies evaluating the impact of minimum pricing policies, and the researchers excluded non-minimum pricing policies or studies without alcohol-related hospital outcomes. The Effective Public Health Practice Project tool was used to assess risk of bias, and the Bradford Hill Criteria were used to infer causality for outcome measures.
Setting
MUP sets a legally required floor price per unit of alcohol and is estimated to reduce alcohol-attributable healthcare burden.
Participant
All studies meeting inclusion criteria from any country
Intervention
Minimum pricing policy of alcohol
Results
22 studies met inclusion criteria; 6 natural experiments and 16 modelling studies. Countries included Australia, Canada, England, Northern Ireland, Ireland, Scotland, South Africa and Wales.
Modelling studies estimated that MUP could reduce alcohol-related admissions by 3%–10% annually and the majority of real-world studies demonstrated that acute alcohol-related admissions responded immediately and reduced by 2%–9%, and chronic alcohol-related admissions lagged by 2–3 years and reduced by 4%–9% annually.
Minimum pricing could target the heaviest consumers from the most deprived groups who tend to be at greatest risk of alcohol harms, and in so doing has the potential to reduce health inequalities.
Using the Bradford Hill Criteria, the researchers inferred a ‘moderate-to-strong’ causal link that MUP could reduce alcohol-related hospitalisation.
Conclusions
Natural studies were consistent with minimum pricing modelling studies and showed that this policy could reduce alcohol-related hospitalisation and health inequalities.