School of Health and Related Research, University of Sheffield, Sheffield, UK.
Addiction. 2010 Mar;105(3):383-93. doi: 10.1111/j.1360-0443.2009.02721.x. Epub 2009 Oct 16.
Context and aims Internationally, the repertoire of alcohol pricing policies has expanded to include targeted taxation, inflation-linked taxation, taxation based on alcohol-by-volume (ABV), minimum pricing policies (general or targeted), bans of below-cost selling and restricting price-based promotions. Policy makers clearly need to consider how options compare in reducing harms at the population level, but are also required to demonstrate proportionality of their actions, which necessitates a detailed understanding of policy effects on different population subgroups. This paper presents selected findings from a policy appraisal for the UK government and discusses the importance of accounting for population heterogeneity in such analyses. Method We have built a causal, deterministic, epidemiological model which takes account of differential preferences by population subgroups defined by age, gender and level of drinking (moderate, hazardous, harmful). We consider purchasing preferences in terms of the types and volumes of alcoholic beverages, prices paid and the balance between bars, clubs and restaurants as opposed to supermarkets and off-licenses. Results Age, sex and level of drinking fundamentally affect beverage preferences, drinking location, prices paid, price sensitivity and tendency to substitute for other beverage types. Pricing policies vary in their impact on different product types, price points and venues, thus having distinctly different effects on subgroups. Because population subgroups also have substantially different risk profiles for harms, policies are differentially effective in reducing health, crime, work-place absence and unemployment harms. Conclusion Policy appraisals must account for population heterogeneity and complexity if resulting interventions are to be well considered, proportionate, effective and cost-effective.
在国际上，酒精定价政策的范围已经扩大，包括有针对性的税收、与通货膨胀挂钩的税收、基于酒精体积（ABV）的税收、最低定价政策（一般或有针对性）、禁止低于成本销售和限制基于价格的促销。政策制定者显然需要考虑在降低人群水平伤害方面各种选择的比较，但也需要证明其行动的相称性，这需要对政策对不同人群亚组的影响有详细的了解。本文介绍了为英国政府进行政策评估的部分结果，并讨论了在这种分析中考虑人群异质性的重要性。方法：我们构建了一个因果、确定性、流行病学模型，考虑了按年龄、性别和饮酒水平（适度、危险、有害）划分的人群亚组的差异偏好。我们根据酒类的类型和数量、支付的价格以及酒吧、俱乐部和餐馆与超市和酒类专卖店之间的平衡来考虑购买偏好。结果：年龄、性别和饮酒水平从根本上影响饮料偏好、饮酒地点、支付价格、价格敏感度和替代其他饮料类型的倾向。定价政策对不同产品类型、价格点和场所的影响不同，因此对亚组有明显不同的影响。由于人群亚组在伤害方面也有明显不同的风险概况，因此政策在减少健康、犯罪、工作场所缺勤和失业伤害方面的效果也不同。结论：如果要对干预措施进行充分考虑、相称、有效且具有成本效益，政策评估必须考虑人群的异质性和复杂性。
