A Scottish adaptation of the Sheffield Alcohol Policy Model Daniel Hill-Mcmanus, University of Sheffield Talk at Health Survey User Meeting, 10 th July 2012.
Talk Overview Background Alcohol Policy Models Scope Method Data Sources Results Alcohol price policy debate in Scotland Next steps and future work
Background 1 Alcohol consumption increasing Annual litres of pure alcohol 1986 1990 1994 1998 2002 2006 2010 Affordability increasing (NHS Information Centre )
Alcohol related harms have increased (Gut 2008) Background 2 Price does affect consumption - Wagenaar et al (2009) - Gallet (2007) - HMRC (2010) - Stockwell et al (2011)
Policy Research In 2008 the UK Government commissioned an Independent Review of the Effects of Alcohol Pricing and Promotion Systematic review of the evidence base Model-based appraisal of policies in a UK context Subsequent studies were commissioned by the Scottish Government and National Institute for Health and Clinical Excellence (NICE) Most recent is 3 rd Scottish Model January 2012
Model Requirements Appraise policies: Across-the-board rises Minimum pricing Restrictions to pricebased promotions Flexible tool: Excel VBA implementation Useable by government analysts Report on priority groups: Under-age drinkers 18 to 24 year old bingers Harmful drinkers Moderate drinkers Estimate outcomes: Costs to health and healthcare systems Wider societal costs Revenue to off-licensed and onlicensed retailers Revenue to government
Overall Model Method Policy Price change Consumption change Pricing model Econometric model Epidemiological model Harm change Manipulation of price distribution ( per 10ml ethanol) using basic supplyside assumptions System of demand equations estimated using iterative three-stage least squares. Risk = fn(consumption) Used to calculate potential impact fraction, similar to Gunning-Schepers (1989) Prevent methodology
Data Sources Required information is fragmented between different sources and must be synthesised: SHeS Self-reported mean and peak consumption of alcohol in 2010 EFS Self-reported expenditure on alcohol (value and volume). 2001/02 to 2005/06 cross-sectional data Various Mortality rates (2010) and hospital admission rates (2010) for alcohol-related conditions Nielsen Off-trade sales at list price and promoted price (no further promo details)
Scottish Health Survey The Scottish Health Survey is used to: Estimate average (e.g. mean weekly consumption) consumption using quantity-frequency questions Binge drinking levels in the UK population using one week heaviest drinking day Derive beverage preferences (e.g. beer, wine, spirits) Obtain basic demographic information of each respondent and other co-variants that may be related to alcohol consumption and harms (e.g., Gender, age, income, education)
Results 1 Population Consumption Change Change in Consumption -20.0% -18.0% -16.0% -14.0% -12.0% -10.0% -8.0% -6.0% -4.0% -2.0% 0.0% -17.9% Without Off-trade Discount Ban With Off-trade Discount Ban -15.1% -16.9% -12.5% -14.0% -10.0% -11.1% -7.8% -6.0% -8.3% -4.6% -3.2% -3.4% -3.7% -5.7% -3.5% -1.9% 25 30 35 40 45 50 55 60 65 70 Minimum Unit Price (pence per unit)
Results 2 Subgroup Consumption Change Change in Consumption -29.0% -24.0% -19.0% -14.0% -9.0% -4.0% +1.0% Hazerdous (M: 21-50, f: 14-35) -25.9% Moderate (M: <21, F: <14) -22.2% Harmful (M: >50, F: >35) -18.6% -16.7% -14.6% -13.6% -10.7% -10.5% -7.5% -10.0% -4.8% -8.0% -6.1% -2.8% -4.3% 25 30 35 40 45 50 55 60 65 70 Minimum Unit Price (pence per unit)
Results 3 Subgroup Change in Spending Change in Consumption 160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 Harmful (M: >50, F: >35) Hazerdous (M: 21-50, f: 14-35) Moderate (M: <21, F: <14) 147.7 138.7 142.7 140.0 123.4 83.9 87.9 76.8 67.1 54.3 8.2 11.2 14.1 16.6 18.8 0.0 25 30 35 40 45 50 55 60 65 70 Minimum Unit Price (pence per unit)
Harms Outcomes Results 4 For a 50p Minimum price (-5.7% consumption) Annual savings: 318 deaths, 6,500 hospital admissions 32,300 days of workplace absence 3,500 crimes Total 10-year valuation: 942m 114m direct health cost savings & 492m QALY gains 24m direct crime cost savings & 20m QALY gains Rest other social care cost (unemployment & workplace absence)
Policy Impact Scotland debate on MUP Chief Medical Officer calls for 50p MUP: Implementing this.. policy.. would save an estimated 1B per year. Original report released by DH. Scottish Government announce plans for MUP. SG brings forward legislation for 45p MUP: These findings confirm that minimum pricing can be a key weapon in the battle against alcohol misuse. Lancet paper published. Scottish elections see SNP gain majority 2009 2010 2011 SG announces plans for MUP in Scotland SG announces plans for MUP set at 50p 2012 SG release UoS 1 st Scottish Adaptation report SG release UoS 2 nd Scottish Adaptation report SG release UoS 3rd Scottish Adaptation report UoS NICE project report released Scottish Parliament votes against MUP legislation but bans offtrade price promotions. English government publish Alcohol Strategy with plans for MUP 50p MUP expected in Scotland: April 2013
Current projects: Next Steps MRC funding to further develop and improved alcohol models Further adaptions: Collaboration with Canadian Institutions to adapt the models to Ontario and British Columbia Adaption of the screening and brief intervention model to Italy, Poland, and the Netherlands
Further Data Sources The Scottish Health Survey was key in providing information on drinking patterns in Scotland This field would benefit most from: Longitudinal data Data collecting both purchasing and consumption Diary data: drinking patterns
Acknowledgments Modelling team: Alan Brennan, Yang Meng, Rachid Rafia, Karl Taylor, Petra Meier ScHARR would like to thank: Frank Dixon and colleagues at the National Records of Scotland for preparing and providing mortality data; Joanne Anderson and colleagues at the Information Services Division Scotland for preparing and providing person specific hospitalisation data, and Julie Ramsay and colleagues at the Scottish Government for providing access to the Scottish Health Survey data for 2010. We also thank Crispin Acton at the UK Department of Health for providing access to market research data procured from CGA Strategy, and the Department for Environment, Food and Rural Affairs for providing access to the low-level Living Costs and Food Survey data (previously known as the Expenditure and Food Survey). The original data creators, depositors or copyright holders, the funders of the Data Collections (where different) and the UK Data Archive bear no responsibility for the analysis and interpretation of the Living Costs and Food Survey, Labour Force Survey, and Offending Crime and Justice Survey data sets downloaded from the Economic and Social Data Service and used in this study.