Assessing Cost-Effectiveness (ACE) of interventions to reduce burden of harm from alcohol misuse: ACE Alcohol Associate Professor Chris Doran National Drug and Alcohol Research Centre, AUSTRALIA 2nd international conference on Public Health
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Assessing Cost-Effectiveness (ACE) of
interventions to reduce burden of harm
from alcohol misuse: ACE Alcohol
Associate Professor Chris Doran
National Drug and Alcohol Research Centre, AUSTRALIA
2nd international conference on Public Health among
Greater Mekong Sub-Regional countries
Drinking levels in the Australian Male Population
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
15
-19
20
-24
25
-29
30
-34
35
-39
40
-44
45
-49
50
-54
55
-59
60
-64
65
-69
70
-74
75
-79
80
+
Age Group
%
Harmful
Hazardous
Low
Abstainer
Hazardous: between 20-40g and 40-60g of pure alcohol daily for women and men, respectivelyHarmful: > 40g and > 60g of pure alcohol daily for women and men, respectively
Cost-effectiveness project (ACE-Alcohol)
• Aim: to assess the cost-effectiveness of interventions to reduce the burden of morbidity and mortality due to hazardous and harmful alcohol misuse in Australia
– Hazardous: between 20-40g and 40-60g of pure alcohol daily for women and men, respectively
– Harmful: > 40g and > 60g of pure alcohol daily for women and men, respectively
Taxation • Volumetric taxation where excise rate is charged according
to alcohol content
Advertising bans• Bans alcohol promotion and advertising, such as advertising
on billboards and sponsorship of community events.
Licensing controls• Restricts the sale of alcohol by limiting the number of hours
and/or days of sale
Brief intervention• General practitioners (GP) screen patients, counsel patients, provide
written materials and provide follow-up consultation
• GP + telemarketing (to boost GP recruitment, and GP support, to encourage more GPs to deliver alcohol advice)
Residential treatment (+ pharmacotherapy)• The intervention mix includes home, outpatient, rural, community
residential and youth residential programs for detoxification, which typically last up to three weeks
• Residential treatment can be followed up with pharmacotherapy to reduce relapse in those who remit
Random breath testing• Involves random breath testing stations (e.g. ‘booze buses’) to detect
and prevent driving with a blood alcohol concentration of more than 0.05, with coverage to achieve an average of one test per driver per year in Australia.
Increase minimum legal drinking age• Increases the minimum age at which alcohol can be legally purchased
or consumed in public from 18 years to 21 years. Changes must be legislated and enforced to have an effect.
Mass media ‘drink driving’ campaigns• A mass media campaign (television, radio, newspapers, billboards, etc.)
to encourage responsible alcohol consumption when driving.
Model
ACE-Alcohol model
Epidemiological data
Intervention data – costs – effects
Disease & injury treatment costs
Health gain (DALYs)Costs (AUS$)
Cost-effectiveness ratio ($/DALY)
Cost-effectiveness planesAcceptability curves
Uncertainty analysis
Results
InterventionDALYs averted
Cost Offsets($million)
Intervention Cost
($million)
Net Cost($million)
Median CER($/DALY)
Taxation 11,000 -$57 $0.58 -$56 Dominant
Advertising bans 7,800 -$31 $20 -$12 Dominant
Min. legal drink age to 21 150 -$0.8 $0.64 -$0.16 Dominant
Licensing controls 2,700 -$11 $20 $8.7 $3,300
GP advice 160 -$1.2 $2.3 $1.1 $6,800
GP advice + telemarketing 340 -$2.6 $6.1 $3.5 $10,000
Drink driving mass media 1,500 -$11 $39 $28 $14,000
Random breath testing 2,300 -$17 $71 $54 $24,000
Res. treat. + naltrexone 460 -$4.4 $59 $55 $120,000
Residential treatment 190 -$1.7 $37 $35 $190,000
CER < $50,000 / DALY is cost-effective
Intervention pathway
-$100
-$80
-$60
-$40
-$20
$0
$20
$40
$60
$80
$100
- 5,000 10,000 15,000 20,000 25,000 30,000
Mill
ion
s
DALYs averted
Inte
rve
nti
on
co
st
AdBans
RBT
Drink drive mass media
ResTreat+NTX
LicCont-OpHrs
Min. legaldrinking age
Brief Intervention
Tax-volumetric
Current practice
Key findings• Current allocation of resources to address alcohol problems is inefficient• Applying volumetric taxation to alcohol is the most effective and efficient
way of reducing harmful alcohol use and alcohol-related harm• Policymakers could achieve over 10 times the health gain if they
reallocated the current level of investment to the optimal package of interventions – volumetric taxation, advertising bans, an increase in the minimum legal drinking age
to 21 years, brief intervention by primary care practitioners, licensing controls, a drink-driving mass media campaign, and random breath testing)
• The location of current practice in the north-east quadrant, relative to the intervention pathway, highlights the substantial amount of population health that could be gained with more effective investment of the health dollars currently spent on alcohol interventions.
Conclusions• The consensus around the world is that governments can
and should take action to reduce alcohol-related harm
• To date, the development of alcohol policy has largely been ad hoc and reactive, with subsequent policy relying on strategies that are ineffective but popular
• Australia (and Vietnam) has a window of opportunity to significantly expand activities to reduce alcohol-related harm
• It is important that the government take this opportunity to reform alcohol policy
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