Cost‐effectiveness of interventions to prevent alcohol‐related disease and injury in Australia

Cobiac, Linda; Vos, Theo; Doran, Christopher M.; Wallace, Angela

doi:10.1111/j.1360-0443.2009.02708.x

Cited by 105 publications

(118 citation statements)

References 25 publications

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“…[4]), the underestimation of overall exposure in such surveys is not surprising. For the conclusions of Cobiac and colleagues [1] this has two consequences: first, the cost-effectiveness ratios for interventions are all underestimated: alcohol interventions such as those examined are even more cost effective compared to other interventions in the health care field. Consequently, there is an even stronger argument for alcohol policy in the current climate of rationing health care!…”

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confidence: 99%

“…Cobiac and colleagues [1] have convincingly demonstrated that science can help the decision making of alcohol policy in the eve of a global alcohol strategy [2]. They combined sophisticated modelling in the tradition of WHO CHOICE methodology (CHOsing Interventions which are Cost Effective: http://www.who.int/choice/en/; for applications to reduce alcohol-attributable harm see [3]) with local expertise (such as derived from the Advisory Board) to compare realistic interventions in Australia for reducing alcohol-attributable health harm.…”

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confidence: 99%

“…In summary, there are exceptional opportunities for improving public health with evidence-based alcohol policies [14], and as demonstrated by Cobiac and colleagues [1] applying such interventions in a country like Australia can be cost effective. The practical value of such research to policy makers ultimately depends on the underlying assumptions made, and the more realistic these assumptions can be, the greater the overall credibility of the research as a tool for making alcohol policy.…”

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confidence: 99%

“…For instance, Cobiac and colleagues [1] base their estimates for the effectiveness of a mass media campaign on a meta-analysis [9], which comes to more optimistic predictions as compared to other evaluations of cost effectiveness [4]. It is thus crucial to discuss the applicability of such transfers from the general intervention literature to the specific situation where alcohol policy is to be applied.…”

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Commentary on Cobiacet al.(2009): How to use science to improve alcohol policy?

Rehm

2009

Addiction

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Commentary on Cobiac et al. (2009): How to use science to improve alcohol policy?Cobiac and colleagues [1] have convincingly demonstrated that science can help the decision making of alcohol policy in the eve of a global alcohol strategy [2]. They combined sophisticated modelling in the tradition of WHO CHOICE methodology (CHOsing Interventions which are Cost Effective: http://www.who.int/choice/en/; for applications to reduce alcohol-attributable harm see [3]) with local expertise (such as derived from the Advisory Board) to compare realistic interventions in Australia for reducing alcohol-attributable health harm. This is a remarkable approach, which constitutes a marked improvement over the more intuitive expert weightings of different policy options, without explicitly modelling the different options given current knowledge about both interventions and population composition and predicted growth (e.g. [4]). While the overall result is important and hopefully will impact alcohol policy, I still see room for improvement.The most crucial aspect of these calculations is the estimation of exposure in the different scenarios, which the authors derived from a nationally representative survey. Yet, what does this mean? First, such surveys notably underestimate per capita consumption as derived from sales and/or production figures. In Australia [5] the level of underestimation in recent surveys was typically by more than 40% [6]. Such underestimates are common in high-income countries [7]. In addition, in case of the underlying survey, the participation rate was less than 50% with an estimated response rate of less than 40%. Moreover, heavy drinking populations such as the homeless or institutionalized were excluded by sampling design for the underlying survey, as well as for most others. As few drinkers account for substantial amounts of overall alcohol consumed (concentration of consumption; see e.g. [4]), the underestimation of overall exposure in such surveys is not surprising. For the conclusions of Cobiac and colleagues [1] this has two consequences: first, the cost-effectiveness ratios for interventions are all underestimated: alcohol interventions such as those examined are even more cost effective compared to other interventions in the health care field. Consequently, there is an even stronger argument for alcohol policy in the current climate of rationing health care! For future publications reporting on surveys and survey-based research, particularly those claiming national representativeness, reporting the coverage rate (i.e. the proportion of per capita consumption covered by the survey) should be made standard in any good journal, as only knowledge of this coverage rate allows comparison with other results [7]. Per capita consumption figures for these comparisons for all countries are available calculated in a standardized way from the World Health Organization (Global Information System on Alcohol and Health: http://www.who.int/ substance_abuse/activities/gad/en/; see also [8], for background).Other as...

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Commentary on Cobiacet al.(2009): How to use science to improve alcohol policy?

Rehm

2009

Addiction

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“…12 Previous studies that were part of ACE prevention reported on physical activity and alcohol interventions. 13,14 We recently reported that 'traffic-light' nutrition labelling and 'junk-food' tax offer excellent value for money as obesity prevention measures. 15 Using the same methods, the present research evaluates whether two dietary interventions to reduce overweight and obesity would be cost-effective in the Australian context.…”

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confidence: 99%

Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity

et al. 2011

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Objective: To analyze whether two dietary weight loss interventionsFthe dietary approaches to stop hypertension (DASH) program and a low-fat diet programF would be cost-effective in Australia, and to assess their potential to reduce the disease burden related to excess body weight. Design: We constructed a multi-state life-table-based Markov model in which the distribution of body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. The target population was the overweight and obese adult population in Australia in 2003. We used a lifetime horizon for health effects and costs, and a health sector perspective for costs. We populated the model with data identified from Medline and Cochrane searches, Australian Bureau of Statistics published catalogues, Australian Institute of Health and Welfare, and Department of Health and Ageing. Outcome measures: Disability adjusted life years (DALYs) averted, incremental cost-effectiveness ratios (ICERs) and proportions of disease burden avoided. ICERs under AUS$50 000 per DALY are considered cost-effective. Results: The DASH and low-fat diet programs have ICERs of AUS$12 000 per DALY (95% uncertainty range: Cost-savingF68 000) and AUS$13 000 per DALY (Cost-savingF130 000), respectively. Neither intervention reduced the body weight-related disease burden at population level by more than 0.1%. The sensitivity analysis showed that when participants' costs for time and travel are included, the ICERs increase to AUS$75 000 per DALY for DASH and AUS$49 000 per DALY for the low-fat diet. Modest weight loss during the interventions, post-intervention weight regain and low participation limit the health benefits. Conclusion: Diet and exercise interventions to reduce obesity are potentially cost-effective but have a negligible impact on the total body weight-related disease burden.

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