Impact of Minimum Unit Pricing on Alcohol-Related Emergency Department Attendances in Scotland: A Natural Experiment Study

Abstract

Evidence before this studyExcessive alcohol consumption is a major cause of disease and death across the world. In the European context, Scotland, where the real price of alcohol has reduced over recent years, is particularly badly affected. There is a dose-response relationship between the alcohol price and the amount consumed. We carried out an initial narrative literature review in 2012 when Minimum Unit Pricing was first considered in Scotland, and updated our review in 2020. We searched Medline, Psychinfo and Google Scholar for papers on alcohol and minimum unit price. Although similar interventions have been implemented elsewhere (e.g. Canada, Russia) the evidence for MUP's impacts on health specifically, as opposed to minimum pricing policies in general (which have often set differing minimum prices based on beverage type), came only from modelling studies, and these showed MUP was the most effective pricing policy for public health. The only empirical study to date has shown a fall in consumption following MUP in Scotland. The level for MUP at 50p per unit of alcohol was set in 2012 based on the modelling, and retained without adjustment for inflation after consultation in 2017. Added value of this studyThis is the first evaluation of the national implementation of MUP based on pure alcohol content to evaluate its impacts on alcohol-related emergency department (ED) attendances, drinking patterns, and alcohol-related diagnosis amongst ED attendees.We found no clear evidence in the ED setting that MUP at a level of 50p per unit of alcohol reduced alcohol-related attendances. Similarly, there was no evidence for a consistent effect on different age, sex and socioeconomic population subgroups. Implications of all the available evidenceWe found no evidence in the ED context that a 50p MUP provides health benefits or harm in Scotland after a one year period. Despite that, if other forthcoming evidence shows MUP improves health in other settings, in combination with recent evidence of reductions in alcohol sales following MUP in Scotland, it would suggest MUP may be worth retaining. We consider our findings to likely reflect the nature of harms within the ED setting and during the relatively short time period studied. Therefore, there may indeed be no effect on ED attendances for MUP at the 50p per unit level. The implication is that the price per unit for MUP should be raised and then further evaluated. Modelling certainly suggested greater effect at an increased price level, so it would be logical to test whether that holds in the real world. Finally, there may be further lessons here for the design of policy and associated evaluations to maximise their chances of finding the clearest results and answers.