Alcohol Price Point

Alcoholism is a huge source of disability and death in our world, as everyone knows. Survey data seem to conclude that about 10% of males and about 3% of females engage in heavy alcohol use, with 10.5% of males and 5.1% of females meeting the criteria for alcohol dependance or abuse in the past year.  Now, as Rick and I discuss on PodMed this week, a complicated study in the Lancet combining economic data with population studies supports the idea that raising the base price of alcoholic beverages would favorably affect alcohol consumption in the group that is most negatively impacted by such consumption: low income people.  Let's examine the study.

The authors employed the Sheffield Alcohol Policy Model, version 2.6, a UK-based database utilizing income and socioeconomic subgroup analysis of alcohol purchase and consumption preferences. Price, type, and place of purchase/consumption were included, as was stratification based on moderate, hazardous and harmful consumers of alcoholic beverages. Moderates were defined as those who consumed less than or equal to 21 units of alcoholic drinks per week for men and 14 for women, hazardous consumed 21 to 50 for men and 14 to 35 for women, and harmful consumed more than 50 among the men and more than 35 among women. A unit of alcohol was calculated as 8 gm or 10 ml of pure ethanol, which of course is not how these beverages are sold, so calculations must be made accordingly. These latter three frequency groups were further categorized into three income groups.  The groups were concomitantly analyzed against rates of morbidity and mortality when a baseline price of 0.45 British pounds ($0.75 US) per unit was imposed on all alcohol sales.

Why was this study done at all, since previous analyses have already estimated that price constraints would disproportionately impact the heaviest drinkers?  What is unique about this study is its use of health data to compel the argument, in light of the fact that the lowest socioeconomic groups bear the biggest brunt of the deleterious consequences of alcohol consumption on both economic and health outcomes. So what did it calculate?

All groups in this analysis immediately reduced consumption when a price floor was established. Those who drank moderately were least impacted, with the greatest change seen in the harmful drinker group, in the lowest income bracket.  Yawn.  But here's the compelling data: persons in the lowest income group would accrue almost 82% of the total reduction in premature death and an increase of over 87% of the quality-adjusted life years of the entire analysis.  Wow!  That's a lot of life saved. As I opine to Rick in the podcast, this model seems to me to be a lot like the one for cigarettes, where increasing price points drive down use, especially among those least able to afford it.  While not usually a fan of the adage that the ends justify the means, in this case such a strategy seems quite supportable and legislators should take note and employ same.  Revenues collected could be diverted to treatment programs thus creating even more benefit to society at large.  A win-win.

Other topics this week include the impact of number of doses of the HPV vaccine received on genital warts in JAMA, a possible treatment for restless legs syndrome in NEJM, and the risk of end-stage renal disease in live kidney donors, also in JAMA.  Until next week, y'all live well.

 

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Mark Noo March 7, 2014 at 12:47 am

I was a drunk. I always drank cheap booze. I didn't like other drugs so substituting another drug for alcohol would not have worked for me. Higher priced alcohol would have slowed or stopped my drinking, but what about those who can substitute one drug for another. Would a higher price simply drive them into the illegal drug market.
America cracked down on the cocaine trade, in response to the crackdown Americans turned to meth.
I tend to think that people who want to mess around with their neurotransmitters to feel better are going to find a way. Especially now that illegal drugs are more widely accepted, or at least used, in America.
In my day, using alcohol was permissible, while using illegal drugs was for addicts who lived in slums. I don't think that norm exists in America anymore.
Anyway, I hope your analysis is correct but I choose to remain more guarded in my hopes.
Thanks for reporting on this.

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