Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
J Stud Alcohol Drugs. 2018 Jul;79(4):514-522.
Evidence on the comparative cost-effectiveness of alcohol control strategies is a relevant input into public policy and resource allocation. At the global level, this evidence has been used to identify so-called best buys for noncommunicable disease prevention and control. This article uses global evidence on alcohol use exposures and risk relations, as well as on intervention costs and impacts, to re-examine the comparative cost-effectiveness of a range of alcohol control strategies.
A "generalized" approach to cost-effectiveness analysis was adopted. A new modeling tool (OneHealth) was used to estimate the population-level effects of interventions. Interventions that reduce the harmful use of alcohol included brief psychosocial interventions, excise taxes, and the enactment as well as enforcement of restrictions on alcohol marketing, availability, and drink-driving laws. Costs were estimated in international dollars for the year 2010 and effects expressed in healthy life years gained. Analysis was carried out for 16 countries spanning low-, middle-, and high-income settings.
Increasing excise taxes has a low cost (<I$0.10 per capita) and a highly favorable ratio of costs to effects (<I$100 per healthy life year gained in both low- and high-income settings). Availability and marketing restrictions are also highly cost effective (<I$100 in low-income settings and <I$500 in high-income settings). Enforcement of drink-driving laws and blood alcohol concentration limits via sobriety checkpoints had cost-effectiveness ratios in the range of I$1,500-3,000. Brief psychosocial treatments were <I$150 and <I$1,500 in low- and high-income settings, respectively.
More than a decade after an initial global analysis, the findings of this study indicate pricing policies and restrictions to alcohol availability and marketing continue to represent a highly cost-effective use of resources.
有关酒精控制策略的成本效益比较的证据是公共政策和资源分配的重要依据。在全球范围内，该证据已被用于确定非传染性疾病预防和控制的所谓最佳购买方案。本文利用全球关于酒精使用暴露和风险关系以及干预成本和影响的证据，重新审查了一系列酒精控制策略的相对成本效益。
采用“广义”成本效益分析方法。使用新的建模工具（OneHealth）来估计干预措施对人群的影响。减少有害饮酒的干预措施包括简短的心理社会干预、消费税以及颁布和执行限制酒精营销、供应和酒后驾车法律。2010 年以国际元估算成本，以获得的健康寿命年数表示效果。在低、中、高收入的 16 个国家进行了分析。
提高消费税的成本较低（<每 0.10 美元），成本效益比非常有利（在低收入和高收入国家，每获得一个健康寿命年的成本均<100 美元）。供应和营销限制也具有很高的成本效益（在低收入国家<100 美元，在高收入国家<500 美元）。通过设置酒精检查站执行酒后驾车法和血液酒精浓度限制的成本效益比在 1500 至 3000 美元之间。在低收入和高收入国家，简短的心理社会治疗的成本效益比分别为<150 美元和<1500 美元。
在最初的全球分析十多年后，本研究的结果表明，定价政策以及对酒精供应和营销的限制仍然是资源的极具成本效益的利用方式。
