Deeming Simon, Kypri Kypros
Health Research Economics, Hunter Medical Research Institute, Newcastle, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
Drug Alcohol Rev. 2021 Jul;40(5):779-799. doi: 10.1111/dar.13242. Epub 2021 Feb 25.
There is a concern in many countries about violence from late-night alcohol sales and appropriate regulatory responses. However, economic losses arising from this activity rarely feature in public debate. Credible estimates are lacking because economic evaluations have not taken a 'societal perspective', costing health, policing and criminal justice outcomes. Our aims were to: (i) develop an analytic model capable of informing cost-benefit analysis of policy changes; and (ii) estimate costs of alcohol-related assault (ARA) in a major city.
We employed decision-analytic cohort models of health and judicial consequences of ARA in Sydney, Australia. We constructed two 6-branch decision-analytic models of patient and offender pathways through the health and judicial systems. We produced overall estimates and analysed their sensitivity to key assumptions.
Combining results from a Health model comprising 40 pathways and 137 cost events, and a Justice model comprising 20 pathways and 48 cost events, yielded an overall cost estimate of $85 093 per ARA, of which 64% was health-related, while 36% was justice-related. Estimates were sensitive to values assigned for 'pain, suffering, morbidity and wellbeing', and to costs of incarceration. Health service-related costs accounted for 1.3% of the total.
The costs of ARA are significant and dominated by incidents in which a victim does not necessarily receive acute medical care but suffers loss in quality-of-life, and where a perpetrator is processed through the criminal justice system. Being derived transparently, within a theoretical framework, the estimates are adaptable to inform cost-benefit analyses of policy options in Australia and other countries.
许多国家都对深夜售酒引发的暴力行为以及适当的监管应对措施表示担忧。然而，这种活动造成的经济损失在公众辩论中很少被提及。由于经济评估未从“社会视角”出发，将健康、治安和刑事司法结果纳入成本计算，因此缺乏可靠的估计。我们的目标是：（i）开发一个能够为政策变化的成本效益分析提供信息的分析模型；（ii）估计一个大城市中与酒精相关的攻击行为（ARA）的成本。
我们采用了澳大利亚悉尼ARA健康和司法后果的决策分析队列模型。我们构建了两个通过健康和司法系统的患者及罪犯路径的六分支决策分析模型。我们得出了总体估计值，并分析了它们对关键假设的敏感性。
将一个包含40条路径和137个成本事件的健康模型以及一个包含20条路径和48个成本事件的司法模型的结果相结合，得出每起ARA的总成本估计为85093美元，其中64%与健康相关，36%与司法相关。估计值对“疼痛、痛苦、发病率和幸福感”的赋值以及监禁成本敏感。与卫生服务相关的成本占总数的1.3%。
ARA的成本很高，主要由受害者不一定接受急性医疗护理但生活质量受损以及犯罪者通过刑事司法系统处理的事件构成。这些估计值在理论框架内透明得出，适用于为澳大利亚和其他国家的政策选择成本效益分析提供信息。
