the effectiveness and cost-effectiveness of alcohol control policies - phe evidence review
TRANSCRIPT
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
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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
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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
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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
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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
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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
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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
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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
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TAXATION
- increase tax
PRICE REGULATION
- minimum prices
Consumption
Affordability
Harm
Taxation and price regulation
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0
50
100
150
200
250
300
350
400
450
19
80
19
81
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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
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Treasury impact statements cost alcohol duty decreases since 2013 at:
£5 billion static
over 5 years
£3.45 billion post behavioural
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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
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-£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
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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
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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
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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