the effectiveness and cost-effectiveness of alcohol control policies - phe evidence review

The effectiveness and cost-effectiveness of alcohol control

policies

PHE Evidence Review

Robyn Burton (Nick Sheron)

20th June 2017

Faculty of Public Health Conference; Telford UK

2 Applied Epidemiology Scientific Conference 2017

In 2014, the Public Health Minister asked PHE to

“provide advice about possible evidence-based

solutions to reduce the public health impact of alcohol,

guided by the best and latest scientific evidence”

Method

• Mixed methods, rapid evidence review

• Evidence synthesis focusing on reviews/meta-analyses and latest evidence

• Search strategy (2010-2015; PubMed/MEDLINE/MeSH terms)

• Data extraction and quality rating

• Commissioned research from UK Health Forum and Sheffield University


1975 ‘Alcohol Control Policies in Public Health Perspective’ (Bruun et al., 1975)

1994 ‘Alcohol Policy and the Public Good’ (Edwards et al., 1994),

2003 ‘Alcohol: No Ordinary Commodity’ (Babor et al., 2003).

2004 ‘Calling time’ AMS

2004 ‘Global Status Report: Alcohol Policy’ WHO

2015 ‘Tackling Harmful Alcohol Use’ OECD

Peer review

1 Internal review of methodology – PHE Research Standards

2 External review of methodology (international reviewers)

3 Quality rating of all evidence by two PHE staff (GRADE)

4 External review - expert advisory group

5 Open peer review event - international expert panel (15)

6 Final review – Mark Bellis

7 External peer review by Lancet from six global alcohol experts



0

20000

40000

60000

80000

100000

120000

140000

160000

180000

Wo

rkin

g ye

ars

lost

Working years lost by underlying cause of death, England 2015

Other attribution

Alcohol-attributable


0

20

40

60

80

100

120

140

160

180

Cancer Alcohol

More years of working life (YWLL) are lost from alcoholthan the seven leading cancers for YWLL combined

Lung cancer Breast cancer Colon / rectum cancer

Brain cancer Pancreas cancer Leukaemia

Oesophageal cancer Alcohol


0

20

40

60

80

100

120

Trends in UK mortality rates standardised to 100% aged under 65

All causes

Circulation

Ischaemic heart disease

Cerebrovascular disease

Cancer

Respiratory

Endocrine metabolic


0

100

200

300

400

500

600

Trends in UK mortality rates standardised to 100% aged under 65

All causes

Circulation

Ischaemic heart disease

Cerebrovascular disease

Cancer

Respiratory

Endocrine metabolic

Liver


TAXATION

AND PRICE

REGULATION

REGULATING

AVAILABILITY

REGULATING

MARKETING

PREVENTING

DRINK-

DRIVING

MANAGING

DRINKING

ENVIRONMENTS

INFORMATION

AND

EDUCATION

BRIEF

INTERVENTIONS

AND TREATMENT

ENVIRONMENT INDIVIDUALS

Policy framework


TAXATION

- increase tax

PRICE REGULATION

- minimum prices

Consumption

Affordability

Harm

Taxation and price regulation


0

50

100

150

200

250

300

350

400

450

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

%

Trends in alcohol related liver deaths in E & W and the affordability of alcohol subtypes - normalised to 100% in 1980

Spirits Afford Index Beer Afford Index Wine Afford Index Cider Afford Index Alcohol related liver deaths

Duty Escalator


Treasury impact statements cost alcohol duty decreases since 2013 at:

£5 billion static

over 5 years

£3.45 billion post behavioural


10% increase in threshold price 32% increase in direct mortality

Zhao, J., Stockwell, T., Martin, G., Macdonald, S., Vallance, K., Treno, A.,

… Buxton, J. (2013). The relationship between minimum alcohol prices,

outlet densities and alcohol-attributable deaths in British Columbia, 2002–

09. Addiction, 108(6), 1059–1069. http://doi.org/10.1111/add.12139


-£2,000

-£1,000

£0

£1,000

£2,000

£3,000

£4,000

£5,000

Phased dutyincreases

Duty freeze Duty cut Phased dutyincreases + 60p

MUP

60p MUP

Cu

mu

lati

ve s

av

ing

ov

er

5 y

ears

(£m

)

Work absence costs

Crime costs

QALY valuation

Direct health care costs

£4 billion

Angus, C., Gillespie, D., Ally, A. K., & Brennan, A. (2015). IN PRESS: Modelling the impact of Minimum Unit Price and Identification and Brief Advice policies

using the Sheffield Alcohol Policy Model Version 3.

Projected cost savings over 5 years


REGULATE

EXPOSURE

REGULATE

CONTENT

Can be embedded by:

- law (statutory)

- voluntary codes of conduct (self-regulatory)

Marketing increases risk that children will

initiate drinking and drink greater quantities in

those who already drink

Regulating marketing

0

50

100

150

200

250

300

350

400

0

1

2

3

4

5

6

1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Th

ou

sa

nd

he

cto

litr

es

Un

its /

week

Average consumption of alcopops and spirits by 10-15 year old schoolchildren in England,overlay = total UK consumption of spirits

Children Spirits

Children Alcopops

Total UK white spirits

Total UK whisky

x 5

Sheron, Gilmore BMJ 2016

Other policy areas

• Strong evidence to support legislative policies to reduce drink-driving

• Moderate / strong evidence to support treatment and brief interventions

• Moderate evidence to support reducing hours of sale

• Moderate evidence to support information and education as tools to

increase awareness (but not change behaviour)

• No strong evidence in favour of policies implemented in and around drinking

environments



Fiscal Policy

Marketing (children)

Availability

Clinical prevention

Clinical treatment

Effectiveness Cost

RAPID EVIDENCE REVIEW OF THE EFFECTIVENESS AND COST-EFFECTIVENESS OF

ALCOHOL CONTROL POLICIES: AN ENGLISH PERSPECTIVERobyn Burton PhD1, Clive Henn RMN1*, Don Lavoie MA1, Rosanna O’Connor BA1, Clare Perkins MSc1, Kate

Sweeney BSc1, Felix Greaves PhD1,2, Brian Ferguson MSc1,3, Caryl Beynon PhD1, Annalisa Belloni MSc1, John

Marsden PhD1,4 , Nick Sheron MD1,5

the effectiveness and cost-effectiveness of alcohol control policies - phe evidence review

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