|
Article Excerpt
A number of attempts to estimate the societal cost of alcohol consumption or abuse for different countries have been made (e.g. Collins & Lapsley 2002; Rehm, Baliunas Biruchu et al. 2006; Johansson, Jarl, Eriksson et al. 2006). These studies try to estimate all adverse effects (health, productivity, crime, etc.) of alcohol consumption in one common unit, i.e. money. There are a number of arguments for conducting such studies, for example making it possible to compare the magnitude of the social problem with other risk factors or across societies with similar or different alcohol drinking habits, and paving the way for policy relevant cost-effectiveness studies. Another argument is that cost estimates are frequently used in the public debate, and sound cost estimations impartially done within the research community lessen the risk of over- and underbidding by the advocates of the different sides of the debate (Single, Collins, Easton et al. 2003).
In order for these cost studies to be as useful as possible, it is imperative that the studies are comparable. This implies that the studies
need to be conducted with a coherent methodology and targeting the same issue. Historically, this has been a problem, with many studies reaching vastly different results, reducing the credibility of all studies. Work to improve comparability started in the mid-1990s and resulted in a set of international guidelines for estimating the costs of substance abuse, published in revised form by the World Health Organization (WHO) (Single et al. 2003). However, if the studies are conducted with coherent methodology, there is still a challenge to compare studies where the data derive, for instance, from different institutional settings and diverge in the availability and level of detail of data (Jarl & Gerdtham 2005). The data available to the researcher and its quality may be expected to vary between countries, which will influence the overall cost estimates.
Cost estimates of alcohol consumption are, in general, difficult to carry out, mainly due to the complexity of the causal relationships involved. Lack of appropriate data is a constant problem, even in countries with rich data. It is obviously even more difficult to conduct cost studies in countries with scanty and questionable data because of the rather intense requirements for a cost of alcohol study. It is important to overcome this problem, especially in order to give all countries the possibility to measure the economic consequences of alcohol and thus more effectively act to reduce societal alcohol costs.
The aim of this study is to investigate the effect of availability and level of detail of data on cost estimates of alcohol consumption. This is done by using the Swedish Cost of Alcohol project (Johansson et al. 2006; Jarl, Johansson, Eriksson et al. 2007) as a baseline and then to examine what happens to the estimates when restrictions are applied on the availability and level of detail of the data. Two different levels of restrictions are imposed on the baseline, each constituting a different model. This subject has not been considered in prior research, at least to the knowledge of the authors, although the result of the present study has earlier been briefly presented in Johansson et al. (2006) in Appendix 3.
The Swedish Cost of Alcohol project (Johansson et al. 2006; Jarl et al. 2007) estimated the cost of alcohol consumption in Sweden for the year 2002. Relevant cost-of-illness methodology was applied using the human capital method and prevalence-based estimates. The study followed the international guidelines (Single et al. 2003), and included cost reductions due to beneficial health effects. The results showed that alcohol consumption in Sweden has an economic net cost, in 2003 prices, of $2.2 billion and a gross cost of $3.2 billon (0.9 and 1.3% of Gross Domestic Product (GDP), as well as an additional net loss of 121,800 QALYs (Quality-Adjusted Life-Years).
The result of the present study will give a sense of the magnitude of the expected bias in the cost estimations of alcohol consumption in countries that suffer from limited availability of and less detailed data compared to countries with richer data (e.g. Sweden). Although it will not, at this stage, allow for adjusting estimates, it can serve as a starting point for a discussion of the extent to which variations in level of detail and availability of data can affect comparisons of costs.
Method
In the present study, what we call the "large model" coincides with the baseline model of the Swedish Cost of Alcohol project, i.e. the best possible cost estimate for Sweden at the time of the study. The model employs all available data for Sweden in the year 2002, supplemented with specific studies in areas where data are scarce. The "small model" assumes the lowest possible data availability expected for a country in the WHO-Euro region, which extends beyond geographic Europe to cover the whole of the former Soviet Union. The model uses data and information that are available through WHO, supplemented with certain basic data that are assumed to be available for all WHO-Euro countries, such as hospital inpatient, mortality, and general crime statistics. The "medium model" takes an intermediate position between the other two models, assuming...
|
