The avoidable costs of alcohol abuse in Australia and the potential benefits of effective policies to reduce the social costs of alcohol
8.2 Methodological implications
This study is one of two international research projects (the second being in Canada) which are applying the International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse (Collins et al., 2006) to the estimation of the avoidable costs of alcohol. The guidelines, which were written in advance of any specific avoidable cost research project, were designed to assist researchers in this area of study. It was always acknowledged by Health Canada, the funding body for the guidelines, that there would be a need for revision in the light of the practical experience gained in these projects. Indeed, one of the objectives of these initial studies was to provide the basis for revision and improvement of the guidelines. It is hoped that, when revised, the guidelines will provide incentive and guidance to other potential researchers, a function which the original WHO International guidelines for estimating the costs of substance abuse (Single et al., 2003) have certainly performed in relation to substance abuse cost studies in several countries.
The avoidable cost guidelines explored four different, but not mutually exclusive, approaches to the estimation of the avoidable costs of substance abuse:
- an epidemiological model;
- the Arcadian Normal approach;
- exposure-based comparators; and
- evidence as to the effectiveness of interventions.
- The epidemiological model makes rigorous data demands which are currently extremely difficult to meet in the Australian environment, and probably in most other environments.
- The Arcadian Normal approach gives some indication of the proportion of the social costs of alcohol abuse which might be avoided, given the adoption of appropriate public policies. However, in itself and without detailed studies of the policies of the Arcadian Normal countries (that is, those countries which performed best in terms of each of the social cost categories) it is not possible to draw any policy conclusions from this approach.
- The alcohol exposure-based approach, which is in a sense an Arcadian Normal approach based on exposure rather than outcomes, suffers from a similar disadvantage. Exposure may give a better indication of potential cost reductions than outcomes based on past and present policies of the Arcadian Normal countries but, in itself, it gives no indication of the policies which should be adopted in order to minimise exposure.
- The intervention effectiveness approach is clearly the most useful in terms of assisting in policy design. It relies on the results of national and international research, but this area of research seems to be expanding steadily and to be providing more definitive results.