The findings are reported in an article published in Online First (www.thelancet.com) and in an upcoming edition of The Lancet, written by Dr Robin Purshouse and colleagues from the University´s School of Health and Related Research (ScHARR) and Department of Economics.
The authors modelled the effects of alcohol pricing and promotion policy options for England. This included across-the-board price increases, policies setting a minimum price per unit (eg, a unit of alcohol, 10 mL ethanol, cannot be sold for less than £0•40) for various possible thresholds between £0.20 and £0.70, and policies restricting price-based promotions (eg, buy-one-get-one-free offers) in the off-licensed trade sector, from prohibiting large discounts only, through to a complete ban. A number of specific population subgroups of special interest to the UK Government were analysed; hazardous drinkers aged 18–24 years, harmful drinkers, and moderate drinkers.
The researchers found that if a minimum cost of £0.50 per unit were introduced*, then 10 years after implementation there could be around 2,900 less premature deaths per year, as well as 41,000 fewer cases of chronic illness and 8,000 fewer injuries each year. This minimum unit price could also result in 92,000 fewer hospital admissions per year, and save the healthcare system in England £270 million each year.
For a minimum unit cost of £0.40, the estimated effects are less marked but still substantial. A decade after implementation, this minimum unit cost would result in 1,200 less premature deaths per year, 17,000 less chronic and 3,000 less acute cases of illness, result in 38,000 fewer hospital admissions, and save the healthcare system in England £110 million.
In terms of additional spending on alcohol, harmful drinkers are affected considerably more than moderate drinkers by minimum price policies. For example, for a 50p minimum price, a harmful drinker will spend on average an extra £163 per year whilst the equivalent spending increase for a moderate drinker is £12. This targeted effect arises because harmful drinkers purchase more of the cheap alcohol that is affected by a minimum price policy.
The research also produced a wealth of other interesting information. In terms of disease, the authors refer to a £0•50 minimum price on the yearly prevalence of illness 10 years after policy implementation. Of 49,000 cases of illness prevented by the intervention, about 30,000 would be in men. Most of the harm reductions arise in chronic disorders in people aged 45 years and older, especially in diseases of the circulatory system (net of any increased cases of coronary heart disease). Reductions are also achieved in alcoholic disorders and alcohol-related acute outcomes, including road traffic accidents and falls.
The research also identified patterns of purchasing. Purchasing preferences vary across the population. Women purchase a higher proportion of their alcohol from off-trade outlets (supermarkets and off-licenses) than men, and people aged 18–24 years purchase alcohol mainly in the on-trade sector (pubs, bars and clubs). Beverage preferences vary, with beer and wine comprising about three-fifths of the alcohol consumed by men and women respectively. For adults, consumption of ready-to-drink beverages (alcopops) is low relative to other types of drink, peaking at 20% of total consumption for women aged 18–24 years.
Consumption patterns also vary. Moderate male drinkers (excluding abstainers) consume on average about 8 units per week and only a small proportion engage in heavy episodic drinking, whereas harmful male drinkers consume on average 80 units and 7 in 10 are heavy episodic drinkers. Health harms also vary, with male harmful drinkers incurring the largest proportion of alcohol-attributable mortality, ill health, alcohol attributable admissions, and healthcare costs.
Of the other pricing policies considered, the authors say: “Prohibition of large discounts (for example buy-one-get-one-free offers) alone has little effect, but tight restrictions or total bans on off-trade discounting could have effects similar in scale to minimum price thresholds of £0•30–0•40. For young adults, and especially for those aged 18–24 years, who are hazardous drinkers, policies that raise the price of cheaper alcohol in the on-trade sector (pubs and clubs) are most effective for achievement of harm reductions.”
The authors concluded: “General price increases are effective for reduction of consumption, healthcare costs, and health-related quality of life losses in all population subgroups. Minimum pricing policies can maintain this level of effectiveness for harmful drinkers while reducing effects on consumer spending for moderate drinkers. Total bans of supermarket and off-license discounting are effective but banning only large discounts has little effect. Young adult drinkers aged 18–24 years are especially affected by policies that raise prices in pubs and bars.
“Minimum pricing policies and discounting restrictions might warrant further consideration because both strategies are estimated to reduce alcohol consumption, and related health harms and costs, with drinker spending increases targeting those who incur most harm.”
Notes for Editors: *See tables 2 and 3, full paper
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