Social cost of heavy drinking and alcohol dependence in high-income countries

Abstract

Objective

A comprehensive review of cost drivers associated with alcohol abuse, heavy drinking, and alcohol dependence for high-income countries was conducted.

Method

The data from 14 identified cost studies were tabulated according to the potential direct and indirect cost drivers. The costs associated with alcohol abuse, alcohol dependence, and heavy drinking were calculated.

Results

The weighted average of the total societal cost due to alcohol abuse as percent gross domestic product (GDP)—purchasing power parity (PPP)—was 1.58%. The cost due to heavy drinking and/or alcohol dependence as percent GDP (PPP) was estimated to be 0.96%.

Conclusions

On average, the alcohol-attributable indirect cost due to loss of productivity is more than the alcohol-attributable direct cost. Most of the countries seem to incur 1% or more of their GDP (PPP) as alcohol-attributable costs, which is a high toll for a single factor and an enormous burden on public health. The majority of alcohol-attributable costs incurred as a consequence of heavy drinking and/or alcohol dependence. Effective prevention and treatment measures should be implemented to reduce these costs.

Appendix 1

Computing proportion of disease attributable to heavy drinking/alcohol dependence as part of all alcohol-attributable disease

The formula for the proportion (fraction) of a disease attributable to heavy drinking (AAF_HD) was derived from the basic formula for AAF. Then AAF_HD was directly calculated from alcohol exposure prevalence proportions in Canada and the disease- and sex-specific risks pooled relative risks (RRs) from meta-analyses (see Rehm et al. 2006) from the below formula. All alcohol-dependence categories (e.g., alcoholic cardiomyopathy or alcoholic gastritis) were set to 100% AAFs by definition.

$$ {\text{AAF}}_{\text{HD}} = \left[ {P_{\text{HD}} ({\text{RR}}_{\text{HD}} - 1)} \right]/\left[ {\sum\nolimits_{i = 0}^{k} {P_{i} ({\text{RR}}_{i} } - 1) + 1} \right] $$

where i exposure category with baseline exposure or no alcohol i = 0; P _i prevalence of the ith category of exposure; RR _i relative risk at exposure level i compared to no consumption.

Using above methodology, we separated the (acute care) hospital days due to HD/AD from the net alcohol-attributable hospital days by broad disease categories. The following fractions attributable to heavy drinking/alcohol dependence were found:

• malignant neoplasms: 29.9%;

• diabetes: 17.3%;

• neuropsychiatric conditions: 86.8%;

• cardiovascular diseases: 45.8%;

• digestive diseases: 61.3%;

• skin diseases: 16.1%;

• maternal conditions: 42.8%;

• other disease conditions—toxicity etc.: 50%.

Overall, a fraction of 60.7% attributable to HD/AD from the net total alcohol-attributable hospital days could be derived. As indicated above, these proportions were calculated in a way that the alcohol-related conditions with an attributable fraction of 100% were included in the broad disease categories. The fractions attributable to HD/AD for different kinds of injuries (43.7%) were directly taken from Patra et al. (2009). Since all non-Canadian studies, with the exception of Germany, did not provide disease-specific costs, we applied the overall proportion (60.7%) of Canada to their individual cost parameters to derive total costs due to HD/AD. In Germany, costs were given by broad disease categories, and it was possible to calculate its overall proportion (58.5%) of HD/AD using Canadian disease specific proportions.