1) In 2014, the UK Public Health Minister asked PHE to provide advice on evidence-based solutions to reduce the public health impact of alcohol. PHE conducted a rapid evidence review on the effectiveness and cost-effectiveness of alcohol control policies. 2) The review found strong evidence that policies like taxation/price regulation and restricting marketing are effective at reducing alcohol consumption and related harms. There is also evidence supporting policies around availability and drink driving. 3) A 10% increase in minimum unit pricing was associated with a 32% increase in direct mortality. Modeling estimated that a policy package including taxation increases and minimum unit pricing could save over £4 billion over 5 years in costs like healthcare, crime, and

1. The effectiveness and cost-effectiveness of alcohol control
policies
PHE Evidence Review
Robyn Burton (Nick Sheron)
20th June 2017
Faculty of Public Health Conference;Telford UK

2. 2 Applied Epidemiology Scientific Conference 2017
In 2014, the Public Health Minister asked PHE to
“provide advice about possible evidence-based
solutions to reduce the public health impact of alcohol,
guided by the best and latest scientific evidence”

3. Method
• Mixed methods, rapid evidence review
• Evidence synthesis focusing on reviews/meta-analyses and latest evidence
• Search strategy (2010-2015; PubMed/MEDLINE/MeSH terms)
• Data extraction and quality rating
• Commissioned research from UK Health Forum and Sheffield University
3 Applied Epidemiology Scientific Conference 2017
1975 ‘Alcohol Control Policies in Public Health Perspective’ (Bruun et al., 1975)
1994 ‘Alcohol Policy and the Public Good’ (Edwards et al., 1994),
2003 ‘Alcohol: No Ordinary Commodity’ (Babor et al., 2003).
2004 ‘Calling time’ AMS
2004 ‘Global Status Report: Alcohol Policy’ WHO
2015 ‘Tackling Harmful Alcohol Use’ OECD

4. Peer review
1 Internal review of methodology – PHE Research Standards
2 External review of methodology (international reviewers)
3 Quality rating of all evidence by two PHE staff (GRADE)
4 External review - expert advisory group
5 Open peer review event - international expert panel (15)
6 Final review – Mark Bellis
7 External peer review by Lancet from six global alcohol experts
4 Applied Epidemiology Scientific Conference 2017

5. 5 Applied Epidemiology Scientific Conference 2017
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
Workingyearslost
Working years lost by underlying cause of death, England 2015
Other attribution
Alcohol-attributable

6. 6 Applied Epidemiology Scientific Conference 2017
0
20
40
60
80
100
120
140
160
180
Cancer Alcohol
More years of working life (YWLL) are lost from alcohol
than the seven leading cancers for YWLL combined
Lung cancer Breast cancer Colon / rectum cancer
Brain cancer Pancreas cancer Leukaemia
Oesophageal cancer Alcohol

7. 7 Applied Epidemiology Scientific Conference 2017
0
20
40
60
80
100
120
Trends in UK mortality rates standardised to 100% aged under 65
All causes
Circulation
Ischaemic heart disease
Cerebrovascular disease
Cancer
Respiratory
Endocrine metabolic

8. 8 Applied Epidemiology Scientific Conference 2017
0
100
200
300
400
500
600
Trends in UK mortality rates standardised to 100% aged under 65
All causes
Circulation
Ischaemic heart disease
Cerebrovascular disease
Cancer
Respiratory
Endocrine metabolic
Liver

9. 9 Applied Epidemiology Scientific Conference 2017

10. 10 Applied Epidemiology Scientific Conference 2017
TAXATION
AND PRICE
REGULATION
REGULATING
AVAILABILITY
REGULATING
MARKETING
PREVENTING
DRINK-
DRIVING
MANAGING
DRINKING
ENVIRONMENTS
INFORMATION
AND
EDUCATION
BRIEF
INTERVENTIONS
AND TREATMENT
ENVIRONMENT INDIVIDUALS
Policy framework

11. 11 Applied Epidemiology Scientific Conference 2017
TAXATION
- increase tax
PRICE REGULATION
- minimum prices
Consumption
Affordability
Harm
Taxation and price regulation

12. 12 Applied Epidemiology Scientific Conference 2017
0
50
100
150
200
250
300
350
400
450
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
%
Trends in alcohol related liver deaths in E & W and the
affordability of alcohol subtypes - normalised to 100% in 1980
Spirits Afford Index Beer Afford Index Wine Afford Index Cider Afford Index Alcohol related liver deaths
Duty
Escalator

13. 13 Applied Epidemiology Scientific Conference 2017
Treasury impact statements cost alcohol duty decreases since 2013 at:
£5 billion static
over 5 years
£3.45 billion post behavioural

14. 14 Applied Epidemiology Scientific Conference 2017
10% increase in threshold price 32% increase in direct mortality
Zhao, J., Stockwell, T., Martin, G., Macdonald, S., Vallance, K., Treno, A.,
… Buxton, J. (2013). The relationship between minimum alcohol prices,
outlet densities and alcohol-attributable deaths in British Columbia, 2002–
09. Addiction, 108(6), 1059–1069. http://doi.org/10.1111/add.12139

15. 15 Applied Epidemiology Scientific Conference 2017
-£2,000
-£1,000
£0
£1,000
£2,000
£3,000
£4,000
£5,000
Phased duty
increases
Duty freeze Duty cut Phased duty
increases + 60p
MUP
60p MUP
Cumulativesavingover5years(£m)
Work absence costs
Crime costs
QALY valuation
Direct health care costs
£4 billion
Angus, C., Gillespie, D., Ally, A. K., & Brennan, A. (2015). IN PRESS: Modelling the impact of Minimum Unit Price and Identification and Brief Advice policies
using the Sheffield Alcohol Policy Model Version 3.
Projected cost savings over 5 years

16. 16 Applied Epidemiology Scientific Conference 2017
REGULATE
EXPOSURE
REGULATE
CONTENT
Can be embedded by:
- law (statutory)
- voluntary codes of conduct (self-regulatory)
Marketing increases risk that children will
initiate drinking and drink greater quantities in
those who already drink
Regulating marketing

17. 0
50
100
150
200
250
300
350
400
0
1
2
3
4
5
6
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Thousandhectolitres
Units/week
Average consumption of alcopops and spirits by
10-15 year old schoolchildren in England,
overlay = total UK consumption of spirits
Children Spirits
Children Alcopops
Total UK white spirits
Total UK whisky
x 5
Sheron, Gilmore BMJ 2016

18. Other policy areas
• Strong evidence to support legislative policies to reduce drink-driving
• Moderate / strong evidence to support treatment and brief interventions
• Moderate evidence to support reducing hours of sale
• Moderate evidence to support information and education as tools to
increase awareness (but not change behaviour)
• No strong evidence in favour of policies implemented in and around drinking
environments
18 Applied Epidemiology Scientific Conference 2017

19. 19 Applied Epidemiology Scientific Conference 2017
Fiscal Policy
Marketing (children)
Availability
Clinical prevention
Clinical treatment
Effectiveness Cost
RAPID EVIDENCE REVIEW OF THE EFFECTIVENESS AND COST-EFFECTIVENESS OF
ALCOHOL CONTROL POLICIES: AN ENGLISH PERSPECTIVE
Robyn Burton PhD1, Clive Henn RMN1*, Don Lavoie MA1, Rosanna O’Connor BA1, Clare Perkins MSc1, Kate
Sweeney BSc1, Felix Greaves PhD1,2, Brian Ferguson MSc1,3, Caryl Beynon PhD1, Annalisa Belloni MSc1, John
Marsden PhD1,4 , Nick Sheron MD1,5 