Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: A modelling study

TY - JOUR

T1 - Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles

T2 - A modelling study

AU - Gibbs, Naomi

AU - Angus, Colin

AU - Dixon, Simon

AU - Parry, Charles

AU - Meier, Petra

N1 - Funding Information: Funding This work was supported by the Wellcome Trust Doctoral Training Centre in Public Health Economics and Decision Science [108903/Z/19/Z] and the University of Sheffield [no award number]. Also the South African Medical Research Council [no award number]. The funders of the study had no role in the study. All authors had full access to all the data in the study and were responsible for the decision to submit the article for publication. © Author(s) (or their employer(s)) 2021.

PY - 2021/8/9

Y1 - 2021/8/9

N2 - Objectives To quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups and wealth quintiles. Design We developed an epidemiological policy appraisal model to estimate the effects of MUP across sex, drinker groups (moderate, occasional binge, heavy) and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance. Setting South African drinking population aged 15+. Participants The population (aged 15+) of South Africa in 2018 stratified by drinking group and wealth quintiles, with a model time horizon of 20 years. Main outcome measures Change in standard drinks (SDs) (12 g of ethanol) consumed, weekly spend on alcohol, annual number of cases and deaths for five alcohol-related health conditions (HIV, intentional injury, road injury, liver cirrhosis and breast cancer), reported by drinker groups and wealth quintile. Results We estimate an MUP of R10 per SD would lead to an immediate reduction in consumption of 4.40% (-0.93 SD/week) and an increase in spend of 18.09%. The absolute reduction is greatest for heavy drinkers (-1.48 SD/week), followed by occasional binge drinkers (-0.41 SD/week) and moderate drinkers (-0.40 SD/week). Over 20 years, we estimate 20 585 fewer deaths and 9 00 332 cases averted across the five health-modelled harms. Poorer drinkers would see greater impacts from the policy (consumption:-7.75% in the poorest quintile,-3.19% in richest quintile). Among the heavy drinkers, 85% of the cases averted and 86% of the lives saved accrue to the bottom three wealth quintiles. Conclusions We estimate that MUP would reduce alcohol consumption in South Africa, improving health outcomes while raising retail and tax revenue. Consumption and harm reductions would be greater in poorer groups.

AB - Objectives To quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups and wealth quintiles. Design We developed an epidemiological policy appraisal model to estimate the effects of MUP across sex, drinker groups (moderate, occasional binge, heavy) and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance. Setting South African drinking population aged 15+. Participants The population (aged 15+) of South Africa in 2018 stratified by drinking group and wealth quintiles, with a model time horizon of 20 years. Main outcome measures Change in standard drinks (SDs) (12 g of ethanol) consumed, weekly spend on alcohol, annual number of cases and deaths for five alcohol-related health conditions (HIV, intentional injury, road injury, liver cirrhosis and breast cancer), reported by drinker groups and wealth quintile. Results We estimate an MUP of R10 per SD would lead to an immediate reduction in consumption of 4.40% (-0.93 SD/week) and an increase in spend of 18.09%. The absolute reduction is greatest for heavy drinkers (-1.48 SD/week), followed by occasional binge drinkers (-0.41 SD/week) and moderate drinkers (-0.40 SD/week). Over 20 years, we estimate 20 585 fewer deaths and 9 00 332 cases averted across the five health-modelled harms. Poorer drinkers would see greater impacts from the policy (consumption:-7.75% in the poorest quintile,-3.19% in richest quintile). Among the heavy drinkers, 85% of the cases averted and 86% of the lives saved accrue to the bottom three wealth quintiles. Conclusions We estimate that MUP would reduce alcohol consumption in South Africa, improving health outcomes while raising retail and tax revenue. Consumption and harm reductions would be greater in poorer groups.

KW - epidemiology

KW - health economics

KW - health policy

KW - HIV & AIDS

KW - public health

UR - http://www.scopus.com/inward/record.url?scp=85112500365&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2021-052879

DO - 10.1136/bmjopen-2021-052879

M3 - Article

C2 - 34373316

AN - SCOPUS:85112500365

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 8

M1 - e052879

ER -