17. chris doran


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17. chris doran

  1. 1. 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
  2. 2. <ul><ul><li>Hazardous: between 20-40g and 40-60g of pure alcohol daily for women and men, respectively </li></ul></ul><ul><ul><li>Harmful: > 40g and > 60g of pure alcohol daily for women and men, respectively </li></ul></ul>
  3. 4. <ul><li>Cost-effectiveness project (ACE-Alcohol) </li></ul><ul><li>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 </li></ul><ul><ul><li>Hazardous: between 20-40g and 40-60g of pure alcohol daily for women and men, respectively </li></ul></ul><ul><ul><li>Harmful: > 40g and > 60g of pure alcohol daily for women and men, respectively </li></ul></ul>
  4. 5. <ul><li>Taxation </li></ul><ul><li>Volumetric taxation where excise rate is charged according to alcohol content </li></ul><ul><li>Advertising bans </li></ul><ul><li>Bans alcohol promotion and advertising, such as advertising on billboards and sponsorship of community events. </li></ul><ul><li>Licensing controls </li></ul><ul><li>Restricts the sale of alcohol by limiting the number of hours and/or days of sale </li></ul>
  5. 6. <ul><li>Brief intervention </li></ul><ul><li>General practitioners (GP) screen patients, counsel patients, provide written materials and provide follow-up consultation </li></ul><ul><li>GP + telemarketing (to boost GP recruitment, and GP support, to encourage more GPs to deliver alcohol advice) </li></ul><ul><li>Residential treatment (+ pharmacotherapy) </li></ul><ul><li>The intervention mix includes home, outpatient, rural, community residential and youth residential programs for detoxification, which typically last up to three weeks </li></ul><ul><li>Residential treatment can be followed up with pharmacotherapy to reduce relapse in those who remit </li></ul>
  6. 7. <ul><li>Random breath testing </li></ul><ul><li>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. </li></ul><ul><li>Increase minimum legal drinking age </li></ul><ul><li>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. </li></ul><ul><li>Mass media ‘drink driving’ campaigns </li></ul><ul><li>A mass media campaign (television, radio, newspapers, billboards, etc.) to encourage responsible alcohol consumption when driving. </li></ul>
  7. 8. 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 planes Acceptability curves Uncertainty analysis
  8. 9. Results Intervention DALYs 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
  9. 11. Intervention pathway
  10. 12. Key findings <ul><li>Current allocation of resources to address alcohol problems is inefficient </li></ul><ul><li>Applying volumetric taxation to alcohol is the most effective and efficient way of reducing harmful alcohol use and alcohol-related harm </li></ul><ul><li>Policymakers could achieve over 10 times the health gain if they reallocated the current level of investment to the optimal package of interventions </li></ul><ul><ul><li>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) </li></ul></ul><ul><li>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. </li></ul>
  11. 13. Conclusions <ul><li>The consensus around the world is that governments can and should take action to reduce alcohol-related harm </li></ul><ul><li>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 </li></ul><ul><li>Australia (and Vietnam) has a window of opportunity to significantly expand activities to reduce alcohol-related harm </li></ul><ul><li>It is important that the government take this opportunity to reform alcohol policy </li></ul>