New research from the University of Sheffield (UK) shows that increasing alcohol prices, for example by establishing a minimum unit price or banning all supermarket and off-licence discounts, could reduce consumption, deaths, and health care costs in all population subgroups. The findings are reported in an Article published Online First (www.thelancet.com) and in an upcoming edition of The Lancet, written by Dr Robin C Purshouse and colleagues.
The authors modelled the effects of alcohol pricing and promotion policy options for England—across-the-board price increases, policies setting a minimum price per unit (eg, a unit of alcohol, 10 mL ethanol, cannot be sold for less than £0•40) for various possible thresholds between £0•20 and £0•70, and policies restricting price-based promotions (eg, buy-one-get-one-free offers) in the off-licence sector, from prohibiting large discounts only through to a complete ban. A number of specific population subgroups of special interest to the UK Government were analysed—hazardous drinkers aged 18 years, harmful drinkers, and moderate drinkers.
The researchers found that, for a minimum cost of £0•50 per unit*, then 10 years after implementation there could be around 2,900 fewer premature deaths per year, as well as 41,000 fewer cases of chronic illness and 8,000 fewer injuries each year. This unit price could also result in 92,000 fewer hospital admissions per year, and save the health-care system in England £270 million each year. Average spend per drinker per year would increase by £37 under this pricing strategy.
For a minimum unit cost of £0•40, the estimated effects are less marked but still substantial. A decade after implementation, this unit cost could result in 1,200 less premature deaths per year, 17,000 fewer chronic and 3,000 fewer acute cases of illness, result in 38,000 fewer hospital admissions, and save the health-care system in England £110 million. Average spend per drinker per year would increase by £22 under this pricing strategy.
In terms of additional spending on alcohol, harmful drinkers are affected considerably more than moderate drinkers by minimum price policies. For example, for a 50p minimum price, a harmful drinker will spend on average an extra £163 per year (+7.2%) whilst the equivalent spending increase for a moderate drinker is £12 (+4.6%). This targeted effect arises because harmful drinkers purchase more of the cheap alcohol that is affected by a minimum price policy.
Of the other pricing policies considered, the authors say: "Prohibition of large discounts (for example buy-one-get-one-free offers) alone has little effect, but tight restrictions or total bans on off-trade discounting could have effects similar in scale to minimum price thresholds of £0•30•40. For young adults, and especially for those aged 18 years who are hazardous drinkers, policies that raise the price of cheaper alcohol in the on-trade sector (pubs and clubs) are most effective for achievement of harm reductions."
The research also produced a wealth of other interesting information. In terms of disease, the authors refer to a £0•50 minimum price on the yearly prevalence of illness 10 years after policy implementation. Of 49,000 cases of illness prevented by the intervention, about 30,000 would be in men. Most of the harm reductions arise in chronic disorders in people aged 45 years and older, especially in diseases of the circulatory system (net of any increased cases of coronary heart disease). Reductions are also achieved in alcoholic disorders and alcohol-related acute outcomes, including road traffic accidents and falls.
The research also identified patterns of purchasing. Purchasing preferences vary across the population: women purchase a higher proportion (54%) of their alcohol from off-trade outlets (supermarkets and off-licenses) than do men (29%), and people aged 18 years purchase alcohol mainly in the on-trade sector (pubs, bars, and clubs). Beverage preferences vary, with 59% of men's alcohol consumption as beer, wine as 60% of women's, and ready-to-drink beverages as 20% of consumption for women aged 18 years.
Consumption patterns also vary. Moderate male drinkers (excluding abstainers) consume on average about 8 units per week and only a small proportion engage in heavy episodic drinking, whereas harmful male drinkers consume on average 80 units and 7 in 10 are heavy episodic drinkers. Health harms also vary, with male harmful drinkers incurring the largest proportion of alcohol-attributable mortality, ill health, alcohol attributable admissions, and health-care costs.
The authors conclude: "General price increases were effective for reduction of consumption, health-care costs, and health-related quality of life losses in all population subgroups. Minimum pricing policies can maintain this level of effectiveness for harmful drinkers while reducing effects on consumer spending for moderate drinkers. Total bans of supermarket and off-licence discounting are effective but banning only large discounts has little effect. Young adult drinkers aged 18 years are especially affected by policies that raise prices in pubs and bars."
"Minimum pricing policies and discounting restrictions might warrant further consideration because both strategies are estimated to reduce alcohol consumption, and related health harms and costs, with drinker spending increases targeting those who incur most harm."
In an accompanying Comment, Professor Ian Gilmore, President of the Royal College of Physicians, London, UK, and Chairman of the Alcohol Health Alliance, UK, and Dr Stephen Atkinson, Royal College of Physicians, UK, say: "We welcome the call for a minimum unit price by the (UK) House of Commons Health Committee, and are heartened that the need for action on alcohol pricing has been recognised by other Members of Parliament, most notably the Secretary of State for Health. A minimum unit price is not a silver bullet for alcohol-related harm—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."
Lancet Editor Dr Richard Horton adds**: "Excessive alcohol consumption has a large cost for society—in disease, death, and social harm. This latest study shows that a minimum pricing policy and restrictions on discounting of alcoholic beverages could significantly reduce consumption and improve health. In the UK, alcohol should be priority target for improving the wellbeing 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."
For Dr Robin C Purshouse and colleagues, University of Sheffield, UK, please contact Lauren Anderson, University of Sheffield media team T) +44 (0)114 22 25339 / 21046 / 29852 E) mediateam@sheffield.ac.uk
For Professor Ian Gilmore, President of the Royal College of Physicians, London, UK, please contact Frank Sooden, RCP press office. T) +44 (0) 20 3075 1468 / +44 (0) 7866 063 013 E) frank.soodeen@rcplondon.ac.uk Lancet Press Office T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com
For full Article and Comment, see: http://press.thelancet.com/alcpricing.pdf
Note to editors: *See tables 2 and 3, full paper
**Please note this is a quote direct from Dr Horton, but does not form part of any Editorial or Comment.
Journal
The Lancet