Raising Alcohol Prices Curbs Drinking, Deaths, Healthcare Costs

Megan Brooks

March 24, 2010

March 24, 2010 — Policies that raise the price of alcohol can reduce consumption, illness, and premature deaths in drinkers and reduce the burden on healthcare systems, according to an article published online March 24 in The Lancet.

Mark Willenbring, MD, an addiction psychiatrist at Allina Mental Health Clinic in St. Paul, Minnesota, and past director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, was not at all surprised by the new findings. "We've known this for decades," he told Medscape Psychiatry.

"In fact, for all the lip service given to reducing harms from alcohol consumption, especially among young people, legislators in the UK and the US have failed to do the single most important thing they could do from a public health perspective and that is raise alcohol taxes," said Dr. Willenbring, who was not involved in the study.

UK researchers led by Robin C. Purshouse, PhD, of the Department of Automatic Control and Systems Engineering at the University of Sheffield in England, created an epidemiological mathematical model to appraise the effects of various alcohol pricing and promotion policies for England, such as across-the-board price increases, policies setting a minimum price per unit of alcohol (10 mL of ethanol) for various possible thresholds between £0.20 and £0.70, policies restricting "buy-one-get-one-free" offers, and policies prohibiting large discounts through to a complete ban.

According to the model, adoption of a mandatory minimum pricing policy of £0.50 per British unit of alcohol (US$0.75) could reduce mean consumption by 6.9%, save more than 2900 lives per year, and yield cumulative health savings to the tune of £6.2 billion (US$9.3 billion) over 10 years.

On an annual basis, such a policy could mean 41,000 fewer cases of chronic illness, 8000 fewer injuries, and 92,000 fewer hospital admissions and save the healthcare system in England £270 million (US$404 million).

"Looking at the estimated effects of setting a £0.50 per UK unit minimum retail price for alcohol, we were interested to see that over half of the estimated reduction in disease prevalence is in the area of circulatory diseases — despite our study including beneficial effects of alcohol consumption for coronary heart disease," Dr. Purshouse told Medscape Psychiatry.

The researchers also looked at the differing effects of pricing and promotion policies on population subgroups such as "hazardous" drinkers aged 18 to 24 years, "harmful" drinkers, and "moderate" drinkers. They found that harmful drinkers (more than 50 units per week for men and more than 35 per week for women) would be affected much more by minimum price policies than moderate drinkers.

This is an important observation, Ian Gilmore, MD, and Stephen Atkinson, MD, of the Royal College of Physicians in London, UK, note in an editorial in The Lancet.

"Concerns have been raised by government and industry that policies to increase the price of alcohol will unfairly penalize responsible moderate drinkers — especially those of limited means," they write.

As for other pricing policies considered, prohibiting buy-one-get-one-free offers and similar discounts alone seemed to have little effect, whereas tighter restrictions or total bans on alcohol discounting in stores and supermarkets have some value.

For young adults aged 18 to 24 years, particularly those classified as "hazardous" drinkers (defined as 21 to 50 units per week for men and 14 to 35 units per week for women), policies that raise the price of alcohol in pubs and clubs "would be most effective" for curbing alcohol-related harm, Dr. Purshouse and colleagues found.

"A minimum unit price is not a silver bullet for alcohol-related harm," Dr. Gilmore and Dr. Atkinson note in their editorial.

"It represents just one of a raft of measures, but to omit it from policy would be to disregard the compelling evidence supporting it. All individuals with an interest in health and society have a responsibility to advocate for a responsible and effective national pricing policy on alcohol so that the burgeoning levels of harm caused by alcohol become a thing of the past," they conclude.

"In the UK, alcohol should be priority target for improving the well-being of our population. Making alcohol more expensive, combined with other measures, is an effective strategy for reducing its harmful effects. The government needs to stop ignoring the growing evidence base for minimum pricing, stop capitulating to the drinks industry, and vote instead for a policy that will deliver better health cost-effectively," The Lancet editor Richard Horton, MD, said in a statement.

The study was funded by the Policy Research Programme, UK Department of Health.

The Lancet. Published online March 24, 2010.

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